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Medical Laboratory Consultants, PLCC
221 South Preston Street
Louisville, Kentucky 40202
502-589-1980 #0149; Fax 502-589-1982
Toll Free: 866-589-1980

Judith L. Cooke, M.D.
Darwin K. Edwards, M.D.
Laszlo Makk, M.D.
Stewart E. Wolfson, M.D.
Thomas P. Eckhoff, Admin
Requisition Form

Ordinarily we ask that you use the specimen requisition forms that we provide you. However, if your supply is exhausted, this form may be printed out for your use. Please order a new supply of forms from us at your earliest convenience (click on the "Order Supplies" button on the left).

The requisition form link below is in PDF (Portable Document Format) and requires Adobe Acrobat Reader to be installed. If you do not have Adobe Acrobat Reader, it is available at no charge from Adobe by clicking on the "Get Acrobat Reader" button below. Once the requisition form is loaded, just hit the print button to print it out. Again, Please order a new supply of forms from us at your earliest convenience (This can be done online -- click here.).

Requisition Form (PDF Format) updated 02/06

Get Acrobat Reader

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