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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: