Collection Kit Request Form
This form should be used to request test kits and test requisitions be sent to a health care provider’s office. Additionally, this form is intended for our standard clinical genomic testing menu and service.
If you would like to request test kits or requisitions for one of our Sponsored No-Cost Testing Programs (i.e. the Lantern Project, ASAH1 Gene Testing, or PPMD Testing Program), please click here.
Who is Kit Being Sent to?
Kit Type (select all that apply)
Test Requisition Form Version (select all that apply)
Contact Information
Shipping Information
Special Instructions