Please locate your purchased Service Level below.  Complete the interactive forms to submit online.

 

Service Level 1/ Initial Assessment -  What you need:  

1.   A copy of the front and back of your medical insurance card (fax to 888-204-5975 or email to billing@geneticcounselingservices.com)

2.   Complete the following interractive forms which are available here:

• Privacy Policy (not required for Institutions)
• Client Intake - Individuals
• Client Intake - Institutions



Service Level 2/ Medical Record Retrieval -  What you need: 

1.   A copy of the front and back of your medical insurance card (fax to 888-204-5975 or email to billing@geneticcounselingservices.com))

2.   Complete the following interactive form from the link you will receive:

• Medical Records Request

  

Service Level 3/ Personalized Risk Assessment -  What you need:

1.   A copy of the front and back of your medical insurance card (fax to 888-204-5975 or email to billing@geneticcounselingservices.com)

2.   Complete the following interactive forms from the link you will receive:

• Family History Questionnaire
• Cancer Risk Assessment (for cancer predisposition testing)

 

Service Level 4/ Insurance Authorization - What you need:

1.   A copy of the front and back of your medical insurance card (fax to 888-204-5975 or email to billing@geneticcounselingservices.com)

2.   Complete the following interactive forms from the link you will receive:

•  Insurance Authorization Request

 

Service Level 5/ Genetic Testing Coordination - What you need:

1.   A copy of the front and back of your medical insurance card (fax to 888-204-5975 or email to billing@geneticcounselingservices.com)

 2.   Complete the following interactive form from the link you will receive:

• Family History Questionnaire
• Cancer Risk Asessment (for cancer predisposition testing)
• Other forms specific to testing will be sent, faxed or emailed to client, and we shall assist you with these forms

  

Service Level 6/ Customized Research - What you need:

Institutions (Insurance Companies and Hospital Systems)

     Complete the following interactive forms which are available here:

• Client Intake - Institutions
• Research Request

 

Individuals

1.   A copy of the front and back of your medical insurance card (fax to 888-204-5975 or email to billing@geneticcounselingservices.com)

2.   Complete the following interactive forms:

• Family History Questionnaire
• Cancer Risk Assessment (for cancer predisposition testing and concerns)
• Medical Record Request
• Research Request Form