Advance Beneficiary Notice

Ambry Genetics
   General Test Requisition

ARUP Laboratories
   Informed Consent for Molecular Genetic Testing
   Patient History for Molecular Genetic Testing

Athena Diagnostics
   Commercial Insurance Test Requisition

Baylor College of Medicine (BCM) Medical Genetics Laboratories
   Billing Information Form
   DNA Test Requisition
   Gene Sequencing (SEQ) Requisition
   Informed Consent for DNA Testing
   Mitochondrial Requisition
   Prenatal Requisition

Blood Center of Wisconsin
   Platelet & Neutrophil Immunology Test Requisition

City of Hope Clinical Molecular Diagnostic Laboratory
   Clinical Molecular Diagnostic Laboratory Test Request Form
   Hemophilia Patient Information Form

Comprehensive Genetic Services (CompGene)
   Consent for Molecular Genetic Testing
   Requisition for Molecular Diagnostic Services

Connective Tissue Gene Tests (CTGT)
   Test Requisition Form I
   Test Requisition Form II

GeneDx DNA Diagnostic Experts
   Informed Consent for DNA Testing for CHARGE Syndrome / CHD7 Gene
   Informed Consent for DNA Testing for L1CAM Gene Testing
   Informed Consent for DNA Testing for Multiple Endocrine Neoplasia Type I
   Sample Submission Form - Testing Services for Rare Mendelian Disorders

Genetic Diagnostic Laboratory & Referral Service - University of Pennsylvania Medical Center
   Informed Consent for Retinoblastoma Testing/Child
   Informed Consent for Retinoblastoma Testing/Adult
   Informed Consent for Retinoblastoma Testing/Tumor
   Informed Consent for Retinoblastoma Testing
   Patient Registration Form
   Request for Retinoblastoma Test
   Verification of Correctly Identified Blood Tubes

IMMCO Diagnostics
   Test Request Form

John Welsh Cardiovascular Diagnostic Laboratory
   Consent Form
   Requisition Form

Massachusetts General Hospital - Neurogenetics DNA Diagnostic Laboratory
   Consent Form for DNA-based Analysis Hyperkalemic periodic paralysis (HYPP)
   Consent Form for DNA-based Analysis Hypokalemic periodic paralysis Type 2(HOPP-2)

Mayo Medical Laboratories
   Informed Consent Form for DNA Testing
   Molecular Genetics - Congenital Inherited Diseases Patient Information Sheet
   Molecular Genetics - Inherited Cancer Syndromes Patient Information Sheet
   Thalassemia/Hemoglobinopathy Information Sheet

MiraVista Diagnostics
   Test Requisition

University of Alabama Medical Genomics Laboratory
   Billing Information
   Informed Consent for NF1 Testing
   Neurofibromatosis Type 1 Test Request Form
   NF1 Phenotypic Checklist Form