Below you can find all of the forms for each specific test option.

If you any questions during the ordering process please do not hesitate to contact us.

Non-Invasive Prenatal Testing – Panorama NIPT

Ontario ordering instructions
B.C. ordering instructions
Alberta ordering instructions
Manitoba ordering instructions
Quebec bilingual ordering instructions

Panorama change authorization form 

Requisitions (Private Pay) Private Pay Requisition
Payment form (required for patients not visiting a LifeLabs, CML or BCBio collection centre)
Requisitions (Ministry Funded) Ontario Requisition MOHLTC-funded
Mandatory Consent Form Patient Consent Form (kept in patient file)
3rd Party Requisitions Dynalife, Alberta
Calgary Lab Services, Alberta
Diagnostic Services, Manitoba

Genetic Carrier Screening – Counsyl

**Please note: this is NOT a prenatal screen and does not test baby’s DNA (a.k.a. placental or fetal DNA)

LifeLabs Requisition (Private Pay)
Patient Consent Form
Payment form (required for patients not visiting a LifeLabs, CML or BCBio collection centre)
MOHLTC application form (Ontario)
Ontario MOHLTC funded requisition (approval number must be indicated on the requisition, top right box)

3rd party requisitions

Dynalife (Alberta)
Calgary Lab Services (Alberta)
Diagnostic Services (Manitoba)

Breast Cancer ProSigna Gene Signature Assay

Requisition & Consent Requisition
Private Payment Payment information

 

Whole Exome Sequencing – Centogene

Requisition & Consent Requisition 
Funding applications (ON) Ontario MOHLTC Application Form

 

Hereditary Conditions – Centogene

Please use the search tool in the upper right hand corner to identify the test code and name. This information is required on page 2 of the requisition.

Requisitions & Consent Requisition
Funding applications Ontario MOHLTC Application Form
Quebec Application Form
British Columbia Application Form