Forms

Access the latest ordering forms, consent forms, and support documents

Everything you need to streamline ordering and patient intake.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Exome and genome TRFs

The most efficient way to place an order is through your GeneDx online ordering portal. However, orders may also be placed by completing one of the TRFs linked below and submitting it with the patient sample. We do not accept orders or patient samples from the UK or EU countries at this time.

For questions, please contact Client Services
Phone: 888-729-1206
Email: Support@GeneDx.com
Fax: 201-421-2010

Global Developmental Delay and Intellectual Disability test requisition

ExomeDx™ and Reanalysis test requisition

GenomeDx™ and Reanalysis test requisition

Rapid and ultraRapid sequencing test requisition

Family member test requisition

Prenatal test requisition

Program TRFs

Alpha Mannosidosis Sponsored Genetic Testing Program test requisition form

Alpha Mannosidosis Sponsored Genetic Testing Program test requisition form

SHANK3

NPC Detect

Zevra Therapeutics is offering a no-cost genetic testing program for individuals with suspected Niemann-Pick disease type C (NPC).

Fabry Disease Sponsored Genetic Testing Program test requisition form

Fabry Disease Sponsored Genetic Testing Program test requisition form

Autism Partnership Program test requisition

Epilepsy Partnership Program test requisition

uRGS GACI Sponsored Testing Program test requisition form

Other TRFs

Global Developmental Delay and Intellectual Disability test requisition

Rare disorders test requisition

Neurology test requisition

Mitochondrial & metabolic test requisition

Ophthalmology / audiology test requisition

Cardiology test requisition

Prenatal test requisition

Add/change test authorization

Contact Us Form

Add / change test authorization form

Insurance forms

Below are forms related to the insurance billing process, including templated letters of medical necessity.

Insurance plans often require specific prior authorization forms for genetic testing. While many of these forms are available in the GeneDx Provider Portal, please check with your patient’s insurance provider for the latest requirements.

Medical necessity language for exome

Medical necessity language for genome

Mitochondrial genome template

Financial assistance forms

We offer a robust Financial Assistance Program to help reduce the potential out-of-pocket costs associated with testing. Our Financial Assistance Program webpage offers additional information and a tool to estimate the level of assistance a patient may qualify for.
Patients may apply for the Financial Assistance Program one week after their sample has been collected and sent to GeneDx. Alternatively, they may apply when they receive their bill (all final bills include a financial assistance application form to ensure easy access).

Financial Assistance Application - Spanish

Financial Assistance Application - English

Genetic counseling services form

To learn more about our genetic counseling services for patients tested by GeneDx, please visit our genetic counseling webpage.

To request services for your patient, please complete one of the forms below

Post-test Genetic Counseling Form

Genetic Counseling Referral Form (download or print and email the completed application to Referral@GeneDx.com or fax to 201-605-6582)

Expedited Request for Prenatal, Rapid, or ultraRapid Post-Test Genetic Counseling

Prenatal, Rapid and ultraRapid Post-test Genetic Counseling Form (download or print and email the completed application to patientGCsupport@genedx.com or fax to 301-238-7217).

Spanish forms

Financial Assistance Application - Spanish

Spanish informed consent

Exome Testing Patient Brochure - Spanish

Genome Testing Patient Brochure - Spanish

Rapid Exome Patient Brochure - Spanish

Medical records request

For GeneDx to release a copy of a patient’s test results to someone other than the ordering provider, please contact our Customer Service team at 888-729-1206 or email Support@GeneDx.com. To request raw data on patients (e.g., sequencing files), please contact our data send out team at Clinicalgenomicsdata@GeneDx.com.

No items found.

Ready to bring genomics into your practice?

We’re here to support every step.