Submit your completed Laboratory Services Form

Please use the below fields to submit your completed Laboratory Services form (e.g. Operator Payment Administration form; Application Moratorium Exemption Request; Application Form; Notification of Change Form, etc.)

Ensure your form is complete and appropriately authorized prior to submitting. Only complete and authorized forms can be processed.

For clarification regarding the submission of a form, please contact Laboratory Services at

To submit an authorized form:

  • Print/scan the completed form and save a digital copy to your computer
  • Complete all information fields below
  • Click [Choose File] and locate the scanned form on your computer
  • Once the file has been uploaded, click [Submit Form]

To report any issues with the secure upload tool, please send an email to

Last Revised: April 01, 2019