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DNA Testing
Informed Consent and Request Forms


 

The following DNA consent form is provided as a generic form in the event that a laboratory specific consent form is not available to you and you are providing genetic testing to your patient and his/her family. 
Some laboratories will require their specific consent form be used.  You should contact the laboratory where the sample will be sent prior to using this form.

This form is not a request form and, as such, a separate request form with the appropriate clinical information, as well as billing information should accompany a sample.

DNA testing is complicated and it is prudent that each family have a thorough discussion as to the limitations and benefits of this testing. Informed consent is of utmost importance.

DNA ANALYSIS - PATIENT INFORMATION AND CONSENT

GENERIC DNA ANALYSIS - REQUEST FORM

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My Family
Health Portrait

Free program to download to help you collect your family health history