Please refer to the instructions below:

Please print out applicable test requisition form and give to your physician:

• General Test Requisition and Preverification Form
• Cancer Test Requisition and Preverification Form
• Cardio Test Requisition and Preverification Form *New*
• Carrier Screen/Prenatal Test Requisition and Preverification Form
• Neurology and Intellectual Disability Test Requisition Form
• Exome Test requisition Form, Pre-verification & Consent form- Proband
• Exome Test Requisition Form & Pre-verification- Proband
• Exome Test Requisition Form - Family members

Have physician collect patient sample (please refer to specimen requirements)

Send sample with test requisition form to:
Ambry Genetics
15 Argonaut
Aliso Viejo, California 92656
United State of America

If you have any questions or need assistance, please contact us:
(International access code) +1-949-900-5500
info@ambrygen.com