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 

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 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

 

 

Ontario Ordering Tips:

STEP 1 – IMPORTANT: Find the test name, test code and correct funding application using our search tool.

NOTE THE TESTING FACILITY (Lifelabs in BC or Centogene in Germany).

STEP 2 – regardless of testing facility location, complete the Lifelabs requisition form (fillable-PDF) fields for doctor & patient info, including test code and test name. Doctor and patient must sign this form. (COVID: no patient signature at this time).

STEP 3 – MOH requires completion of their new fillable-PDF form: MOH funding application 05JUL21.pdf

STEP 4 – Attach the saved requisition form to the MOH funding application and submit to MOH, as per application instructions.

STEP 5 – immediately email the two completed forms (include any pertinent clinical notes – optional) to: BCGenetics@LifeLabs.com

STEP 6 – patient must be given a copy of these forms to take with them for their blood draw appointment at a convenient Lifelabs location.

 

 

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