Pathology Core Lab Work Request Form

Core Laboratory Contact Information

Patricia Latham, M.D.


This form should be filled out prior to dropping off specimens. Please make sure your work request form and specimen container have proper identifying information on them.

Basic Information


Drop off person/other contact information

Method of Payment

Note: Investigators outside of GW requesting work, please make payment via check to the remittance address provided.

I hereby certify that I have personally filled out this form and the information in complete and accurate. By signing this section of this work request, I agree to abide by and be subject to the University's rules, regulations, and disciplinary code. I further understand that it is my responsibility to assure that all documents necessary to complete my work request arrive in a timely manner.

Work Requested

Type of work requested - Check all that apply

Specimen Information

Animal Tissue

Human Tissue

Sample IDs


Special Staining


Frozen Sectioning