Specimen Collection Request

Specimen Collection Request Form

Please complete the form to make a request.

Enter HCI Code

Example: 20M0163, Click here to go to HCI Website

Clinic Name

Street Address

Postal Code

Request Type

Collection Date/Time

Remarks

Requested by

Clinic Staff Name

Please tick to acknowledge and proceed with the submission.

Request for specimen collection will only be processed during Mon-Fri 8:30-16:30 / Sat 8:30-12:30. Forms submitted outside these hours will be processed on the next available working day. Please note that we are closed on Sunday and Public Holiday.