Courier Pickup Request

Please use this form to request a courier pickup for delivery to Pacific Orthotic Laboratory.

Courier service is available on Tuesdays and Thursdays throughout most of the Seattle metro and Eastside areas, including Lynnwood, Snoqualmie, Renton, and West Seattle.

Important: All items submitted for pickup must include a printed RX Order Form with the practice name, provider information, and instructions to the lab clearly filled out.  Please do not submit electronic forms for courier pickup items — a physical copy must accompany the materials being picked up.

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Provider @ Practice Name *

example: Great Clinician @ POL Medical

Contact the When

City & Zip *

example: Woodinville, 98072

Contact Name & Telephone Number *

Who do we contact if we have questions or are unable to schedule the courier at your location?

When can we get the item? *

• Pickup ASAP (the item is ready now for Tuesday/Thursday pickup).
• Delayed Pickup (additional details required).

If choosing Delayed Pickup, please use the Additional Pickup Instructions (below) to specify when the item will be available.

Additional Pickup Instructions

Optional: Provide any additional pickup instructions as required. Do not include any order details here.

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