Tip for Provider/insurer-specific

Gather as much family medical history as possible before your appointment — including ages of diagnosis and any genetic test results

Tip for Provider/insurer-specific

Many genetic counselors now offer telehealth appointments

Tip for Provider/insurer-specific

Genetic counseling is covered by most insurance plans, especially when ordered for a specific medical indication

Genetic TestingeasyDoctor signature required

Genetic Counseling Referral Form

Provider/insurer-specific · Healthcare systems / HMOs

Referral for genetic counseling services. Required by HMOs and some PPOs before genetic testing. Genetic counselors provide pre- and post-test counseling.

Form Details

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Where to Submit This Form

🌐

Find a genetic counselor through the NSGC directory

https://findageneticcounselor.nsgc.org/

Search by specialty and location.

🏢

Request a referral from your primary care physician or specialist

Your doctor can refer you to a genetic counselor at a hospital or clinic.

🌐

Call a genetics center directly to schedule

Many genetics clinics accept self-referrals — no doctor's referral needed.

Required Attachments

📎 Physician referral (if required by your insurance)
📎 Family medical history (as detailed as possible for 3 generations)
📎 Relevant medical records, pathology reports, and previous genetic test results
📎 Insurance information and prior authorization (if required)

Processing Time

Appointment scheduling: 1-4 weeks depending on clinic availability. Genetic counseling sessions typically last 30-60 minutes.

What Happens Next

The genetic counselor will review your personal and family history, assess risk, discuss testing options, and provide guidance on results. A summary letter will be sent to your referring provider.

Tips for This Form

✓ Gather as much family medical history as possible before your appointment — including ages of diagnosis and any genetic test results
✓ Many genetic counselors now offer telehealth appointments
✓ Genetic counseling is covered by most insurance plans, especially when ordered for a specific medical indication
✓ You do NOT have to proceed with genetic testing after counseling — it is a decision-support process

More Genetic Testing Forms

Genetic Testing Prior Authorization

Insurer-specific · Health insurance plans

Request for coverage of genetic tests (BRCA, Lynch syndrome, pharmacogenomics, carrier screening, etc.). Must meet personal and/or family history criteria.

Genetic Testing Lab Requisition

Lab-specific (Invitae, Myriad, Ambry, GeneDx, etc.) · Genetic testing laboratories

Lab-specific order form including clinical indications, family history, insurance information, and patient consent. Labs often handle prior authorization directly.

GINA Notice (Employer Wellness Programs)

EEOC-compliant notice · Employers

Notice to employees about GINA protections when wellness programs request genetic or family history information. Employers with 15+ employees cannot use genetic information in employment decisions.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Healthcare systems / HMOs or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.