All specimens sent to the Center must accompany a completed Test Request Form. For autopsy cases, the Autopsy Consent and Testing and Reporting Policies Forms must be completed and submitted to the Center along with clinical history/medical records of the patient. Delays in reporting may result without this information.
The forms avaiable on this page are in Adobe PDF format. You may download the free Adobe Acrobat Reader to view these files by clicking on the link below. If you have any questions, please contact us at 216-368-0587 or by email at firstname.lastname@example.org.
Test Request Form
The Test Request Form must be completed for all samples submitted to the Center. The Center is fully compliant with HIPAA regulations.
Testing and Reporting / Genetics Consent Form
The Testing and Reporting Genetics Consent Form must be completed whenever blood or frozen brain tissue is sent to our Center in order to release genetic results.
Cerebrospinal Fluid, Biopsy and Genetic Billing Requisition Form
The CSF, Biopsy and Genetic Billing Form must be completed ONLY when sending cerebrospinal fluid, biopsy tissue or blood for genetic testing to our Center for testing and we are to bill patient directly.