Get Stool Request Form

Completing the Stool Request Form online is a straightforward process that allows users to request stool analyses efficiently. This guide provides clear instructions on each section of the form to ensure accurate submissions.

Follow the steps to fill out the Stool Request Form online.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Fill in your family name and first name in the designated fields.
3. Enter your complete address, including zip code and city.
4. Provide your country of residence in the appropriate field.
5. Include your phone number for contact purposes.
6. Input your date of birth in the designated area.
7. Select your sex by indicating either male or female.
8. Record the date and hour when the sample was taken.
9. Enter the name of the requesting physician.
10. Fill in your patient reference number as required.
11. Choose the type of intestinal flora analysis you are requesting by marking the corresponding box.
12. If you are requesting an antibiogram, check the relevant options for Staphylococci, Streptococci, Enterococci, or Enterobacteriaceae.
13. Indicate any additional antibiotic testing requests in the space provided.
14. Acknowledge your understanding of the laboratory's policies by reading and signing the form.
15. Finally, save your changes, and you can then download, print, or share the completed form.

Complete the Stool Request Form online to ensure your analysis is processed promptly.