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CLIA Application Forms

Certification - Medical (Clinical) Labs

The following forms are in Adobe .pdf format. Adobe Reader is required to download and open the forms.


Click here to download free Adobe Reader.

 

To apply for CLIA certification or update an existing CLIA certificate:

 

Certification Level

Credentials
Waiver

None
Provider
Performed
Microscopy

Must be a physician, dentist, or mid-level provider. Include a copy of the Colorado license (wallet card).
Compliance or Accreditation

Choose highest level of lab testing performed:
moderate complexity testing sites or lower pdf file
high complexity testing sites or lower pdf file

To prepare for a two-year survey (Certificates of Compliance) or if chosen for a validation survey (Certificates of Accreditation):

 

 

Return completed forms via fax to 303-344-9965
Do not send the instruction pages.

 

 

References:

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