RESULTS REQUEST Precision Representative * (Your name) Requester name: * (client/customer requesting results) Requester Phone #: Would they like a call back? * NO, JUST SEND RESULTS YES, NEEDS AN EXPLANATION OF RESULTS RE-SEND RESULTS Is the Requester the person who paid for the service? (Verify that the requester paid to be able to dictate where results go) YES NO COULDN'T VERIFY Donor name: * (Donor that went in for testing) Full name Date collected MM DD YYYY Specimen ID #: Email for results * (Email MUST be from whoever paid for the test) Is this urgent? (This section is for you to detrmine) Yes this is urgent No, it has not been passed 5 business days Additional details: Thank you!