Fillable Identity Verication for Online Result Delivery

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Identity Verication for Online Result Delivery

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ATTN: Customer Contact Center
212 Cherry Lane
New Castle DE 19720
E-mail document and copy of ID to: VerifyID@LabCorp.com OR Fax to: 877-259-1386
OR Mailing address:
Identity Verication for Online Result Delivery
You must complete the requested information below. Requests will be
processed within three (3) business days.
A copy of a Driver’s License or other Government Issued Photo ID must
accompany this document.
Patient Name:
Date of Birth: Daytime Phone:
FOR DEPENDENT INDIVIDUALS:
Caregiver (Primary Registered User)
Name:
Email Address:
Note: Lab test results will not be forwarded to the online account if the information provided is illegible.
©2019 Laboratory Corporation of America® Holdings. All Rights Reserved. 23830-0620
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Identity Verication for Online Result Delivery

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Completed 14 September 2020

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