If You Have Any Questions, Please Contact Brian Oliver at

/ ASCP Permissions Form
for the American Journal of Clinical Pathology, Pathology Patterns Reviews, LabMedicine, Check Sample, and LabQ (formerly Tech Sample)

In order to obtain copyright permission to use and/or reprint materials published by the American Society for Clinical Pathology, you must first submit a permission request with the necessary information.

Please completethe form, save it, and return it as an attachment via e-mail to Brian Oliver (). Your request will be processed within three to four business days.

Important:If you do not complete all required fields, your request will be returned to you for completion.

If you have any questions, please contact Brian Oliver at .

/ ASCP Permissions Form
for the American Journal of Clinical Pathology, Pathology Patterns Reviews, LabMedicine, Check Sample, and LabQ (formerly Tech Sample)

Name*:

Address*:

Fax Number*:

E-mail Address*:

If you have any questions, please contact Brian Oliver at .

/ ASCP Permissions Form
for the American Journal of Clinical Pathology, Pathology Patterns Reviews, LabMedicine, Check Sample, and LabQ (formerly Tech Sample)

Information regarding material(s) requested

If you have any questions, please contact Brian Oliver at .

/ ASCP Permissions Form
for the American Journal of Clinical Pathology, Pathology Patterns Reviews, LabMedicine, Check Sample, and LabQ (formerly Tech Sample)

Author(s) of article *:

Title of article *:

Title of journal*:

Year *:

Page Number(s) of article*:

Volume Number:

Issue Number:

If you have any questions, please contact Brian Oliver at .

/ ASCP Permissions Form
for the American Journal of Clinical Pathology, Pathology Patterns Reviews, LabMedicine, Check Sample, and LabQ (formerly Tech Sample)
What would you like permission to do? (place an “x” on the line next to your selection)
Photocopy an article
Use text and/or a figure, image, or table
Specific materials to be used:
Do you intend to use the material for print or electronic purposes? * (place an “x” on the line next to your selection)
Print Use Only
Electronic Use Only / Print and Electronic Use

If you selected any electronic use, provide details regarding the electronic format you intend to use *:

Will the material be used for commercial purposes or educational purposes? * (place an “x” on the line next to your selection)
Commercial Use / Educational Use

Briefly state how the material will be used(include all publishing and/or electronic use details, if applicable) *:

* - Must be completed in order to process your request.

If you have any questions, please contact Brian Oliver at .