Provider Forms

If you’re a healthcare provider, you can easily find and download the forms most frequently used during the genetic testing process below.

The quickest way to place an order is via our online provider portal. Alternatively, you may place an order through client services at 301-519-2100, option 3 or submit a Test Requisition Form (TRF) via email to or fax (201-421-2010).

Please note: GeneDx does not accept orders or specimens from the UK or European Union (EU) countries at this time.

Test Requisition Forms (TRF)

Consent Forms

GeneDx’s standard patient informed consent form can be found below, in multiple languages.  Our patient informed consent form is also included with all of our test requisition forms, as the last two pages.

Letters of medical necessity (LMN)

Exome Sequencing

Genome Sequencing

Rapid Genome Sequencing



Insurance & Financial Assistance





Horizon BCBS NJ


United Healthcare


Financial Assistance Program Forms

At GeneDx, we firmly believe that everyone deserves access to vital insights from genetic testing, regardless of their financial situation which is why we offer a robust Financial Assistance Program to help reduce the potential out-of-pocket costs associated with testing.

The program has broad eligibility criteria, meaning that most patients will qualify for some level of financial assistance.

Please send the form below to your patient and have them return the completed, signed application to  

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)

Sample templates

Medical Records Request

In order to receive copies of patient medical records for patients who have received genetic testing that was ordered by another healthcare provider (e.g., genetic test results), please contact our Customer Service team at (888) 729-1206, option 3, or email To request raw data on patients (e.g., sequencing files), please contact the data send out team at