Forms and Requisitions

 

To order a genetic test, please complete the following forms with your patient:

  • Requisition form
  • Consent form
  • Payment form (if applicable)
  • Provincial healthcare funding application (if applicable)

Forms are reviewed and updated periodically. Review this page regularly to ensure you are using the latest versions.

If you have any questions about the tests or the ordering process, please do not hesitate to contact us.

 

Genetic Tests for Reproductive Health

Non-Invasive Prenatal Testing
Panorama™ Forms*

Update:

Panorama is now able to screen twin pregnancies, as well as pregnancies conceived using egg donors and surrogates!

Panorama™ is a Non-Invasive Prenatal Test (NIPT) that screens for common genetic conditions caused by extra or missing chromosomes in the baby’s DNA as early as 9 weeks. Panorama analyzes baby’s (placental) DNA through a simple blood draw from the mother’s arm.

Ordering Instructions

Mandatory Patient Consent Form (Kept in Patient File)

Requisition Forms

Payment Form

 Requisition Change Form

Sample Reports

*Forms last updated in May 2020

Expanded Carrier Screening Forms*

The Expanded Carrier Screening test will help parents understand their own genetic carrier status with disorders like cystic fibrosis, so they can make informed family planning decisions. Unlike traditional “wait and see” approaches to having children, the LifeLabs Carrier Screen option reduces anxiety to bring peace of mind to the couple.

Requisition Form

 LifeLabs Private Pay Requisition Form 

Payment Form

Sample Reports 

Genetic Tests for Cancer

Genetic Testing of 47 genes for Inherited Cancer Susceptibility

Our hereditary cancer panel offers a pan-cancer screening approach that includes full sequencing and copy number variant analyses of 47 of the more common genes associated with increased risk of developing hereditary breast, ovarian, uterine, colorectal, gastric, prostate, melanoma, and pancreatic cancer. Pre- and post-test genetic counselling is included.

Ordering Instructions

All Provinces

Mandatory Patient Consent Form

Patient Consent Form for BRCA1/2 English

Patient Consent Form for BRCA1/2 French

Requisition Forms

Hereditary Cancer+ Counselling Requisition Private Pay  English

Hereditary Cancer + Counselling Requisition Private Pay  French

Healthcare Professional Detail Aid 

BRCA1/2 Physician Resource

Hereditary Cancer Risks and References


Genetic Tests for Hereditary Conditions*Forms last updated in April 2020

(Forms for 3500+ Genetic Tests)* 

These 3500+ diagnostic and predictive single gene and genetic panel tests provide concrete, actionable insights that lead to informed decision making and personalized treatment.
Search for a test using our Search tool to access a full range of diagnostic, predictive, carrier, and prenatal genetic tests completed at our lab in Toronto or by our partner CENTOGENE
Please use the search tool to identify the test code and name on page 2 of the requisition.

Ordering Instructions

  • Ontario

  • BC

  • Private Pay Payment Form
  • Patients in other provinces and territories need to submit a requisition, consent form, and sample to LifeLabs Genetics as per the instructions in the kit.

Requisition and Patient Consent Form

Application for Ministry Funding

*Forms last updated in November 2019

 Pharmacogenetics

TreatGx Plus Testing Service

Download the Requisition for TreatGx Plus

TreatGx Plus suggests safe effective medication options by looking at medication-to-medication, medication-to-disease, and medication-to-genetic interactions. These results lead to personalized medication and dosage options. The service spans  hundreds of medications and dozens of common conditions.

To register for the software, please click here. Each order includes a home collection kit delivered directly to your patient and a subscription to the medication decision-support software.

How to Change a Requisition

  • Changing Genetic Testing Instructions

    At LifeLabs Genetics, we are keen to provide useful, accurate, and reliable results. If your patient’s details change and you’d like to update a requisition that you’ve already submitted, contact us. We may be able to adjust the test to meet your new requirements within the usual turnaround time or send you an altered report.

  • Changing a Panorama™ Requisition

    The Panorama™ non-invasive prenatal test has a specific change authorization form. If the due date changes or the parents would now like to know the baby’s gender, for example, please complete and submit this form to speed up the change process.

Contact Us

Genetic testing can seem complicated. Our team of certified genetic counsellors and client-care specialists are available to support you along the way.

To ensure we provide you with the correct information, please select your province.

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To ensure we provide you with the correct information, please select your province.
  • British Columbia
  • Ontario
  • Alberta
  • Manitoba
  • New Brunswick
  • Newfoundland and Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon