Tip for Lab-specific (Invitae, Myriad, Ambry, GeneDx, etc.)

Ensure the informed consent specifically covers the scope of testing and potential for secondary/incidental findings

Tip for Lab-specific (Invitae, Myriad, Ambry, GeneDx, etc.)

Ask about the lab's re-analysis and variant reclassification policies

Tip for Lab-specific (Invitae, Myriad, Ambry, GeneDx, etc.)

Discuss what Variants of Uncertain Significance (VUS) mean before testing

Genetic TestingmoderateDoctor signature required

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.

Form Details

Total fields: 45
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Where to Submit This Form

📬

Mail specimen and requisition to the genetic testing laboratory

The ordering provider's office typically handles specimen collection and shipping.

🌐

Submit electronically through the lab's provider portal

Many labs allow electronic requisition with specimen shipping kits.

Required Attachments

📎 Completed lab requisition form (lab-specific)
📎 Patient demographic and insurance information
📎 Clinical indication and family history
📎 Informed consent for genetic testing signed by the patient
📎 Specimen (blood, saliva, or tissue) collected according to lab specifications
📎 Prior authorization number (if required by the insurer)

Processing Time

Test turnaround time varies by test type: targeted single-gene: 1-2 weeks; multi-gene panels: 2-4 weeks; whole exome/genome: 6-12 weeks.

What Happens Next

The laboratory will process the specimen and generate a report. Results are sent to the ordering provider, who will review them with the patient — often with a genetic counselor.

Tips for This Form

✓ Ensure the informed consent specifically covers the scope of testing and potential for secondary/incidental findings
✓ Ask about the lab's re-analysis and variant reclassification policies
✓ Discuss what Variants of Uncertain Significance (VUS) mean before testing
✓ Some labs offer financial assistance or cash-pay options — ask before assuming insurance will be denied

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 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.

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 Genetic testing laboratories 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.