Home
 Research Request Form - Individuals
Forms must be completed/ submitted prior to leaving our website

Forms must be completed/ submitted prior to leaving our website
1. DATE:

1. DATE:

Date
2. Name:

2. Name:
3. For whom are you requesting that genetic research be done?

3. For whom are you requesting that genetic research be done?

(self or another person?)
4. How is this individual related to you?

4. How is this individual related to you?

(If applicable)
4. What type of research are you requesting?

4. What type of research are you requesting?
5. What research have you already done for your question?

5. What research have you already done for your question?


6. What information have you received related to your question?

6. What information have you received related to your question?

Please list source

7. Has any genetic testing already been done regarding your matter?

7. Has any genetic testing already been done regarding your matter?


8. Do you have report(s)?

8. Do you have report(s)?
9. Where was testing done and when?

9. Where was testing done and when?
Verifier

Verifier

For security purposes, we ask that you enter the security code that is shown in the graphic. Please enter the code exactly as it is shown in the graphic.
Your Code
Enter Code

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. 

Copyright © Genetic Counseling Services Schenectady, New York
info@geneticcounselingservices.com