Medical Genetics Laboratories at Baylor College of Medicine
Requisition and Consent Forms


To access all the forms listed below, you will need: Adobe Acrobat Reader.

Cancellation Policy:
Test orders may only be cancelled if the following procedure is completed before 5:00pm (central time) the next business day after the sample is received. Cancellation orders received after that time cannot be honored, and tests will be performed, charged, and reports issued. This includes tests cancelled for billing (financial responsibility) issues:

  1. Call Client Services 1-800-411-4363 or 713-798-6555 for cancellations or revisions.
  2. A Test Cancellation/Revision form will be faxed to your institution for an authorized signature. Upon completion, please fax form to 713-798-6584.
Requisition Forms:
Updated
Autism Testing
5/28/09
Mitochondrial - Mitochondrial Diagnostic Checklist is included
9/10/09
Biochemical (PDF)
9/4/09
Cancer Cytogenetics (PDF)
8/1/09
Cancer DNA (PDF) - consent form included
9/10/09
Cytogenetics (PDF)
6/11/09
DNA - Non-Sequencing (PDF) - consent form included
10/8/09
Gene Sequencing (PDF)
11/2/09
Personalized Medical Genomic Profile (PDF)
9/1/09
Prenatal (PDF)
11/2/09
Prenatal Chromosomal Microarray Analysis (PDF) - consent form included
5/28/09
   
Additional Consent Forms:  
Huntington Disease (HD) Consent Forms - Required
10/1/09
Mitochondrial Research Consent Form
7/9/08
   
Institutional Only Forms:  
Biochemical Genetics Laboratory Requisition for Analyte Tests (PDF)
9/4/09
Biochemical Genetics Laboratory Requisition for Enzyme Tests (PDF)
9/4/09
New York State Only: Cystic Fibrosis Carrier Panel Requisition with Physician Consent
5/28/09
   

Other Forms:

 
Genetic Information Authorization (PDF)
5/28/09
Authorization for Release of Surgical Tissue and Pathology Report (PDF) - HNPCC Screening
5/28/09

Baylor College of Medicine

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