Invitae | Forms

Easy online ordering

Place your order online for more efficient order processing, faster report delivery, and access to additional online features. Setting up an account only takes a few minutes, and you can also browse and order directly from our online test catalog.

An Invitae online account enables you to:

Design and save custom orders for easy reordering.
Securely share test results with patients and colleagues.
Order on behalf of clinicians in your organization.
Track order status in real time and keep a record of previous orders.
Securely message Invitae staff and upload documents.
View and download your test reports.

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Invitae continually updates its panels based on the most recent evidence. Please note that if an order is placed using an older version of these forms, Invitae reserves the right to upgrade any ordered panel(s) to the current version(s). To avoid confusion, please consider placing your order online. If you choose to place an order using one of the forms below, please use Adobe Acrobat for the best experience.

Diagnostic tests

Test requisition forms:

Hereditary cancer order form
Hereditary cancer simplified order form
Cardiology and neurology order form
Pediatric, metabolic, and nephrology disorders order form (includes porphyrias)
Immunology, dermatology, hematology, and ophthalmology order form
General diagnostic order form (includes FVT/VUS)

Patient consent forms:

Panel tests: Patient informed consent
Panel tests (Spanish): Patient informed consent
Exome tests: Patient informed consent
Authorization to use and disclose health information

Please note that there is no paper requisition form for exome testing. It can only be ordered online. This allows Invitae to best capture the detailed phenotypic information necessary for the most accurate analysis and interpretation.

Forms associated with diagnostic tests performed at the Invitae Irvine laboratory:

Test requisition and other forms:

Chromosomal developmental disorders order form

Patient consent forms:

Chromosomal microarray, karyotype, and FISH analysis: Patient informed consent

Reproductive health tests

Test requisition and other forms:

Carrier screening order form
Non-invasive prenatal screening (NIPS) order form
Preimplantation genetic testing (PGT) order form
Preimplantation genetic testing (PGT-SR) patient referral form

Patient consent forms:

Carrier testing: Patient informed consent
Non-invasive prenatal screening (NIPS): Patient informed consent
Preimplantation genetic testing: Patient informed consent

Forms associated with reproductive health tests performed at the Invitae Irvine laboratory:

Test requisition and other forms:

Pregnancy loss analysis order form
(miscarriage, recurrent pregnancy loss, IUFD, stillbirth)
Prenatal diagnosis order form

Patient consent forms:

Chromosomal microarray, karyotype, and FISH analysis: Patient informed consent

Proactive health screens

Test requisition forms:

Proactive testing order form (US only)
Proactive testing order form (International)

Patient consent forms:

Patient informed consent (US only)
Patient informed consent (International)

Billing and financial assistance

Credit card authorization form
Letter of medical necessity (LMN)
Invitae Patient Assistance Program application Precertification form: Aetna (BRCA)
Precertification form: Blue Cross Blue Shield of North Carolina (BRCA)
Precertification form: PriorityHealth
Precertification form: UnitedHealthcare (BRCA)
Precertification form: Tufts Health Plan
Precertification form: PreferredOne
Precertification form: Cigna (HBOC)

Statement of medical necessity: Providence Health Plan (BRCA/HBOC)
Statement of medical necessity: Providence Health Plan (Long QT)
Statement of medical necessity: Providence Health Plan (Lynch syndrome)
Precertification form: Ped-I-Care / Children's Medical Services FL
Precertification form and statement of medical necessity: BCBS Federal Employee Program (HBOC)
Precertification form and statement of medical necessity: BCBS Federal Employee Program (Lynch Syndrome)
Order cancellation request form
Order cancellation request form (Spanish)

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Easy online ordering

Diagnostic tests

Test requisition forms:

Patient consent forms:

Forms associated with diagnostic tests performed at the Invitae Irvine laboratory:

Test requisition and other forms:

Patient consent forms:

Reproductive health tests

Test requisition and other forms:

Patient consent forms:

Forms associated with reproductive health tests performed at the Invitae Irvine laboratory:

Test requisition and other forms:

Patient consent forms:

Proactive health screens

Test requisition forms:

Patient consent forms:

Billing and financial assistance

Looking for brochures and patient guides?

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Looking for something?

Find the forms you need to complete your order here

Easy online ordering

Diagnostic tests

Test requisition forms:

Patient consent forms:

Forms associated with diagnostic tests performed at the Invitae Irvine laboratory:

Test requisition and other forms:

Patient consent forms:

Reproductive health tests

Test requisition and other forms:

Patient consent forms:

Forms associated with reproductive health tests performed at the Invitae Irvine laboratory:

Test requisition and other forms:

Patient consent forms:

Proactive health screens

Test requisition forms:

Patient consent forms:

Billing and financial assistance

Looking for brochures and patient guides?

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