Diagnostics Requisition Form Customer Information Name Phone Number Email Address Sample Information Sample Category DNA RNA Sample Type Blood EDTA Buccal Swab Tissue Body fluid Other Sequencing Platform Type Do you have any preference in the sequencing platform? If so, please specify PacBio Revio PacBio Onso Illumina NovaSeq X Plus Sanger Sequencing Others (please specify) Test Intended For Genetic Testing is intended to identify Onco findings Pre\Perinatal history Metabolic findings Hearing Impairment Skin\Hair findings Vascular system Personal Wellness Neurological findings Endocrine findings Gastrointestinal findings Eye Defects\Vision Musculoskeletal Genotiurinary findings Cardiac findings Respiratory findings Hematologic or Immunologic findings Structural Brain Abnormalities Craniofacial\Dysmorphism Developmental\Behavioral findings Others Any additional information Send
