Ambry Genetics has a rapidly-expanding list of resources that can be very helpful when preparing for genetic testing. Below we have listed consent, letters of medical necessity and several other forms that will assist you in preparing for, processing and completing your genetic testing.

Test Requisition Forms now have editable fields for ordering clinician, additional results recipients, and institutional billing fields.
To create "pre-filled" forms, download then enter the desired information and print to PDF. (Cannot "save as" and store entered information via Adobe Reader.)

Test Requisition & Preverification Forms

Letters of Medical Necessity

Family History Forms

Advance Beneficiary Notice Of Noncoverage (ABN)


State of New York Forms

Sample Submission Requirements

Client Satisfaction Survey

Aetna Prior Authorization Form for BRCA1/2 Testing

  • Aetna Prior Authorization Form for BRCA1/2 Testing

    NOTE: This form is only required for Aetna patients, for any test that includes the BRCA1 and/or BRCA2 genes.  This form can be faxed beforehand to (949) 900-5501, or submitted along with the lab requisition and specimen. Once received, Ambry will complete the preauthorization process on the patient's behalf.