Request a Kit

ORDER A SPECIMEN KIT

Please note, only medical providers can place an order for a specimen kit for genetic testing. If you are a patient or family member of a patient, please contact your medical provider’s office to have a kit order placed. Completing the form below DOES NOT constitute placing a test order. All test orders must have a completed test requisition form.

Deliver kit to patient’s home

Patient Full Name*

Parent/Guardian Name, if patient is a minor*

Patient Address*

Patient Phone Number*

Patient Email*

How will the test requisition (order) form be submitted?*

Health Care Professional (HCP) Information

Health Care Professional First Name*

Health Care Professional Last Name*

Health Care Professional Institution*

Health Care Professional Email*

Health Care Professional’s NPI Number

Phone Number

Delivery Address Line 1*

Delivery Address Line 2

City/Town*

State*

ZIP Code*

Kit Types

If you would like a kit shipped to a patient's home, please select only one of the following

Number of Single Test Buccal Swab Kits (one swab in each kit)

Number of Reflex Kits (two swabs in each kit) Please order this kit if reflex testing is being ordered

Number of Optical Genome Mapping Blood Collection Kits

Other Information

REQUEST A KIT

ORDER A SPECIMEN KIT

Health Care Professional (HCP) Information

Kit Types

clinical
services

Pediatric Neurodevelopmental Disorders

Genome-Wide Structural Variant Assessment

Prenatal Testing

Neuromuscular Disorders

Hematologic Malignancies

Medication Metabolism

Clinical Resources

Data Services

Clinical Services

REQUEST A KIT

ORDER A SPECIMEN KIT

Health Care Professional (HCP) Information

Kit Types