Forms

 

• Requisition Form: Call Customer Service to request—800-862-1013 or 608-224-4272

• Fax Authorization Form: Complete and Fax this form to 844-390-6233 to authorize Fax reporting of WSLH results for your facility.  Please contact the WSLH Customer Service group at 800-862-1013 for additional information.

• Supplies Order Form: For collection kits or other supplies complete and Fax this form to 844-390-6233.

• Patient Travel History Form (Updated 08/23/2019)