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All external users should complete the external request form. We ask that the forms are completed in full and if handwritten, in block capitals so that the form is legible. Missing information could lead to a delay in testing as some information is vital in order for a case to be booked in. 

Please find and download the relevant request forms below. Please contact  the Molecular Specimen Reception on 0121 371 3325 or This email address is being protected from spambots. You need JavaScript enabled to view it. with any queries regarding the request forms.

Lung Cancer Testing
including EGFR, ALK, PD-L1 & ROS


Lung Cancer Request Form

EGFR Mutation Testing on Circulating Tumour DNA


EGFR Circulating Tumour DNA Request Form

Colorectal Cancer Testing
including KRAS, NRAS, BRAF, MMR IHC & MLH-1 
Colorectal Cancer Request Form
GIST Testing
including KIT & PDGFRA and BRAF 
GIST Testing Request Form
PD-L1 Lung Cancer Testing Prior to Pembrolizumab Therapy
including PD-L1 22C3 IHC
PD-L1 Lung Cancer Request Form
PD-L1 Bladder Cancer Testing Prior to Pembrolizumab or Atezolizumab Therapy
including PD-L1 22C3 IHC & PD-L1 SP142 IHC
PD-L1 Bladder Cancer Request Form
PD-L1 Breast Cancer Testing
PD-L1 Breast Cancer Request Form 
Melanoma Testing
including BRAF, NRAS, KIT and PD-L1 28-8 
Melanoma Testing Request Form 
Breast and Gastric Cancer Testing
including IHC & FISH 
Breast and Gastric Cancer Request Form 
Neuropathology Molecular Testing
Molecular Neuropathology Testing Request Form 
Thyroid Cancer Molecular Testing
including IHC & PCR 
Thyroid Cancer Testing Request Form 
PD-L1 Head & Neck Cancer Testing
including 28-8 & 22c3 
Head & Neck PD-L1 Request Form 

 

Molecular Pathology - Request a Test

 

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