Forms and Requisitions

• Genetic Tests for Reproductive Health
• Genetic Tests for Cancer
• Genetic Tests for Hereditary Conditions
• Tips to complete and send forms – click here

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*

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.

*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.

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.

Genetic Tests for Hereditary Conditions

(Forms for 10,000+ Genetic Tests)* 

These 10,000+ 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 British Columbia or by our partner CENTOGENE.

How to Order

• All Provinces in Canada – Combined Private Pay and Requisition Form EN 
• All Provinces Outside of Ontario Requisition Form Only
• Quebec – Réquisition Pour Test Hereditaire
• British Columbia – Requisition Form & Out of Province/Out of Country Funding Application

Ontario Ordering Tips 

• Ministry of Health-funded testing (The lab requisition, patient consent and funding application forms are now conveniently combined)

STEP 1

• IMPORTANT: Find the test name, test code and correct funding application using our search tool. 

STEP 2

• Complete the lab requisition portion FIRST (pages 1-5) including fillable-PDF fields for doctor, office, test code, test name, as well as patient information.
• All information entered above will then be automatically entered into MOH funding application form. Ensure all other fields of the funding form are completed (clinical diagnosis, etc.).

STEP 3

• Doctor and patient (guardian) sign and date both the requisition and MOH funding form sections.

STEP 4

• Immediately fax combined form to Ontario MOH, using fax number at the top of the funding form.

STEP 5

• Patient takes a copy of ALL forms, including any pertinent clinical notes (optional) to their local community LifeLabs facility for their specimen draw.