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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 regarding the submission of a form, please contact Laboratory Services at labfacilities@phsa.ca
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 labfacilities@phsa.ca
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user@domain.ca
250-123-4567
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(PDF, JPG, PNG, GIF, BMP. Click to add file. Multiple files can be attached one at a time.)
Warning: Do not upload patient demographic data.