Request Form

INSTRUCTIONS:

Complete form: To order a test, please download and complete a copy of the test request form above.  The test must first be authorised by a certified, registered health practitioner and associated medical history information provided. Please read the form carefully and fill in both pages of the form as well as the Medical Questionnaire.

Signatures: Please ensure both practitioner and patient have signed the request form where required. Genostics will not proceed with an order unless these signatures are present; this is a legality and is strictly adhered to.

Send the completed test request form to Genostics to complete the order. The form can either be faxed (+61 2 8088 7097) or scanned and emailed (admin@genostics.com.au).

Test requests will only proceed if signatures and payment details are complete.