PerkinElmer Genomics

AnyPanel™ Custom (D3000) Gene Submission Tool

Directions

Please fill in all of the fields below including the submitting provider's name, patient's name, clinical indication for testing., and requested gene list.
A unique panel ID code will be generated upon submission. Please include this code in the appropriate box on the test requisition form to ensure appropriate processing.

Provider Name (first last)*

Provider Email Address*

Patient Name (first last)*

Clinical Indication for Testing*

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Requested Genes

Please enter all requested genes for your custom panel below. Entry via copy and paste is accepted. Individual genes should be separated by a comma, single space, or one gene per line. Please note that currently only HUGO Gene Nomenclature will be accepted through this submission tool.

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