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Genetic Counselor Professional Interest Form
  Forms must be completed/ submitted in one session

Forms must be completed/ submitted in one session

  Provider Form

Provider Form

1.  Name

1. Name


2.  E-mail contact information

2. E-mail contact information


3.  Current Employment Affiliation(s)

3. Current Employment Affiliation(s)

Please indicate the hours of your present employment.  

4.  For Counselors Interested in Learning about Employment Opportunities

4. For Counselors Interested in Learning about Employment Opportunities

Are you interested in providing consultation to patients and clinicians by telephone?  Would you be interested in policy research or other projects that require genetic counselor skills?  What is your experience in these areas?

5.  What is your availability?

5. What is your availability?

Please provide information as to your availability on Mondays, Tuesdays, Wednesdays, Thursdays and Fridays between 8 a.m. and 8 p.m. EST for any 2, 3, or 4 hour stretch. 

6.  What are your areas of Specialization?

6. What are your areas of Specialization?




7.  Are you licensed in any state? Which state(s)?

7. Are you licensed in any state? Which state(s)?


8.  Please mention your particular skills

8. Please mention your particular skills

Also, are you board certified or eligible at this time? Please send your resume to info@geneticcounselingservices.com if you would like us to contact you with work opportunities.  

9.  Professional Liability Insurance

9. Professional Liability Insurance

Please indicate whether you carry any professional liability insurance.  Also, have any claims or suits have ever been made against you?  Have any circumstances occured that may result in a claim against you?  Have you ever been declined, cancelled or non-renewed by any insurance company?   If yes, could you provide detailed information.  

10.  Minimum Acceptable Hourly Rate

10. Minimum Acceptable Hourly Rate

Please describe the reimbursement that you require.    Don't be afraid to speak up for your worth.

Genetic Counseling Services is a venture that removes the middleman from the service delivery of genetic counseling. No promises, but we do not accept contracts that do not value the professional services of Genetic Counselors.  

11.  Message/ Questions/ Comments

11. Message/ Questions/ Comments


12.  Please Describe your Present Availability

12. Please Describe your Present Availability

Please check all that apply: 
13.  Verifier

13. Verifier

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Discussions with a genetic counselor as offered by Genetic Laboratories and Genetic Testing Companies serve to provide key information for the understanding of genetic testing, although pedigree intake and record review may be focused to the results of genetic testing.  Although laboratory license and permit and genetic counselor certification and licensure where applicable, do not permit the practice of medicine, genetic counselors can provide explanation and direction to physicians and authorized medical professionals for the interpretation of the results of genetic testing.  Genetic counselors, upon physician waiver and in collaboration with ordering clinicians, can provide counseling on genetic testing and the meaning of test results. Comprehensive genetic counseling may be available through physicians who can provide genetic counseling within the scope of their practices as they choose and through genetic counselors within the scope of their practice. Please note that patient management and genetic counseling surrounding on-going prenatal or any diagnostic testing is best handled by Physicians, Maternal/Fetal and Pediatric Genetics specialists,  in conjunction with clinical services where they are available and in collaboration with genetic counselors and other genetic specialists. 

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info@geneticcounselingservices.com