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Get UW School Of Dentistry Request For Laboratory Study 2016-2024

L: omps uw.edu dental.washington.edu/oralpath *Please consult our referral email policy. Please include copies of the front and back of medical and dental insurance cards. State law requires patient s name and date of birth on biopsy bottles. Please select one of the following No Insurance Medical & Dental Attached Please Bill Doctor Date of Biopsy (MM / DD / YYYY ) PATIENT INFORMATION PLE A SE T YPE OR PRINT CLE ARLY Patient s Name (Last).

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