United States, Canada, and Australia:
Test Requisition Form (English)
Informed Patient Consent (English - US only)
Informed Patient Consent (English - Outside US)
Program Flyer (English)
Formulário de Solicitação em papel (Português)
Formulário de Consentimento Informado do Paciente (Português)
Folheto/Panfleto do Programa e Instruções para Pedidos no Brasil (Português)
Argentina, Chile, Colombia, Mexico:
Formulario de Solicitud de Prueba (Español)
Consentimiento Informado del Paciente (Español)
Folleto del Programa y Instrucciones de Pedido (Español)
If you don’t find answers with your initial order, the
Leukodystrophies sponsored testing program includes one re-requisition within 90 days to genes within the original clinical area.
Simply log into your account, navigate to the order, and click "Add rerequisition”
If a positive result is identified, testing for your patient’s family members is available.
Simply follow the ordering instructions, selecting only the gene(s) you are interested in testing for the family member. The partner code will automatically be added with the order.
If you're a patient and believe you are eligible for this sponsored testing program, you have options:
Contact Genome Medical
(available in US only)
Schedule a genetic counseling session, by phone or video, with an expert who can review your testing options and place the order. There is a cost associated with the Genome Medical services, which may be covered under your health benefits.
Discuss the program with your doctor
If you already have a healthcare provider who can place this order, you can download this flyer to take to your own provider.
Find a local genetics provider
Search our genetics providers network to find a provider in your area. Please sign in, or create an account, to connect with our network of professionals. There may be a cost associated with the provider’s services.
Invitae Corporation (NYSE: NVTA) is a leading medical genetics company, whose mission is to bring comprehensive genetic information into mainstream medicine to improve healthcare for billions of people. Invitae's goal is to aggregate the world's genetic tests into a single service with higher quality, faster turnaround time, and lower prices. For more information, visit the company's website.