CONTACT US

For all Services: (Except institutions)

 1.  A copy of the front and back of your medical insurance card is required.  Select any one of 3 ways to do this:
 Fax ( after copying to paper)  to 888-204-5975   OR e-mail either a copy or a picture taken with your phone to        info@geneticcounselingservices.com               
 

  2. Complete and submit  the Forms below for the Service you have requested at your convenience, but at least 2 days prior to your appointment.  

  3.   Please be advised that as you complete any forms below, if you leave the site prior to completion of any form, all information entered will not be saved  for that form. It is also important that you remember to hit the submit button once you have finished filling out a form.

Service Level 1/ Initial Assessment

Forms to submit online:  

• Privacy Policy (not required for institutions)
• Client Intake and Consent Form- Individuals
• Cancer Risk Assessment
• Family History Questionaire



Service Level 2/ Medical Record Retrieval

Forms to submit online:

•  Medical Records Request
•  Myriad Laboratories Authorization Form.  (Authorization to Use and Disclose Protected Health Information