Laboratory form request

If you are already a patient of the Primelab practice and you are due to have your periodic blood test, please fill out the form underneath and you will receive the form for the blood tests by e-mail.

When you go to the laboratory for blood withdrawal, please take good notice of the following points:

Remember to bring with you an official ID (passport, driving licence) and your health insurance card.
Fasting blood values are preferable. So, if possible, have your blood drawn after fast of at least eight hours. Prior to having blood drawn you can have a glass of water or cup of tea (no milk or sugar!). Coffee is not allowed.
Do not take medication / hormones / nutritional supplements in the morning prior to blood withdrawal, unless this is imperative from a medical point of view. Of course, once your blood has been drawn, you can take your medication / hormones / nutritional supplements.
Pre-menopausal women preferably should have their blood drawn during day 21-25 of their menstrual cycle (start counting from day 1 (one), the first day of your last menstruation).

Name:*
First Last
Date of Birth:*

Day
Month
Year
E-mail address:*
Comments regarding the lab-tests (if applicable):
Conditions for the request of a laboratory form:*
- I am already a patient of Primelab.
- I realise the costs for the laboratory-tests are NOT reimbursed by your healthcare insurance and I have to pay for these costs myself. I also realise the costs of laboratory-tests are NOT included in the costs of the consultations.

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