Access the latest ordering forms, consent forms, and support documents
Everything you need to streamline ordering and patient intake.
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: [email protected]
Fax: 201-421-2010
Other TRFs
Consent forms
GeneDx’s standard patient informed consent form can be found below in several languages. The English version is also appended to all test requisition forms. Information related to sample retention and database participation is included in the consent forms.
If a patient would like to opt-out of being recontacted for research participation, opt-out of sharing deidentified data with collaborators, update their health information exchange (HIE) preferences, or request the discarding of their sample, please use the additional forms below.
Insurance forms
Below are forms related to the insurance billing process, including templated letters of medical necessity and forms related to the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.
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.
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).
When they are ready to apply, patients can complete and sign the electronic Financial Assistance Application in English or Spanish.
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
Genetic Counseling Referral eForm*
Genetic Counseling Referral Form (download or print and email the completed application to [email protected] or fax to 201-605-6582)
Rapid and ultraRapid Genetic Counseling Referral eForm
Rapid and ultraRapid Genetic Counseling Referral Form (download or print and email the completed application to [email protected] or fax to 301-238-7217).
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 [email protected]. To request raw data on patients (e.g., sequencing files), please contact our data send out team at [email protected].