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Request forms

A fully completed request form should accompany each sample and some requests also require a pre-request form.

Request forms must be legible (it is possible to type the information into the available PDFs) and provide:

  • patient's full name
  • date of birth and NHS / hospital number
  • patient's postcode
  • name and address for invoicing for non-NHS referrals
  • full name and address of referring clinician
  • referral reason and test/s required
  • information regarding any known or suspected infection risks (e.g. HIV / Hep B & C / TB) must be clearly documented

Request forms

Pre-request forms

Whole Genome Sequencing (WGS)

Referral forms and sample requirements for whole genome sequencing are available on the following website:

West Midlands Regional Genetics Laboratory

Specific queries about WGS

Email: bwc.centralsouthglh@nhs.net

Last reviewed:10 November 2023