Request FormS


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. Patients are to fill in the yellow sections of the form and practitioners are to fill in rest of the form.

Signatures: Please ensure both practitioner and patients have signed the request form in the appropriate places. Genostics will not proceed with the test 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 (

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

Further details about ordering a test, what to do when the test kit arrives, and how the results are distributed to your doctor can be found by clicking here