Each test order requires a specific set of forms to be submitted with specimen samples. Forms are included with test kits and can also be downloaded and printed from this page.

If you are using your own sample collection materials, please pay special attention to the sample collection instructions on the form corresponding to the kind of test you are ordering in the Specimen Collection and Processing section.

You will need to complete all forms sent with your test kit for each patient sample, including billing information. Samples cannot be processed until complete and legible information is received.

+Complete Test List
  • Complete Test List
+Test Request Forms
Form Completion Instructions:
  • Instructions for Completion of Test Request Forms
Test Request Forms by Test Type:
  • Carrier Screen Test Request Form
  • Known Familial Mutation Test Request Form
  • MNG Exome™ Sequencing Test Request Form
  • MNG Healthy Exome™ Test Request Form
  • MNGenome® Test Request Form
  • Neurochemistry & Metabolic Test Request Form
  • Next-Generation Sequencing Test Request Form
  • RNA Sequencing Test Request Form
  • Single Gene, mtDNA & Repeat Expansion Requisition Form
  • Custom Next-Generation Sequencing Test Request Form
  • Sequencing Reassessment Request Form
Test Request Form for Add-On Orders:
  • Add-On Test Request Form
+Patient Clinical Information Form
  • Clinical Information Form
+Consent Forms
  • Carrier Whole Exome Sequencing Test Consent
  • Informed Consent for Data Release
  • Healthy Whole Exome Sequencing Consent Form
  • Informed Consent for Data Reassessment
  • Informed Consent for Genetic Testing – NY State Compliant
  • Whole Exome & Whole Genome Sequencing Consent Form
+Laboratory Forms
  • Authorization to Release Protected Health Information
  • NY State Approved MNG Testing List
  • NY State Non-Permitted Laboratory Test Request Approval Form
  • Specimen Release Form
  • Verbal/Unclear Order Form
+Specimen Collection and Processing Forms
  • Blood and Plasma Collection and Processing Form
  • RNA Sequencing Collection Instructions
  • CSF Collection and Processing Instructions – With and Without MNG Kit
  • Plasma Collection for Phenylalanine Loading Assay
  • Solid Tissue Collection and Processing Form – Genetic Testing Only
+Billing Forms
  • Direct Payment Options Form
  • Institutional Billing and Payment Form