Cytogenetics Forms

Please include a completed requisition form, and billing information form with specimens sent for cytogenetics. Work will not begin on samples that arrive without the completed paperwork.

Cytogenetics Requisition Form--use this form when ordering routine chromosome analysis and FISH studies.

Billing Information Form

ABN Waiver--required for Medicare patients, refer to Medicare approved diagnosis list.

Tricare Waiver--required for Tricare patients, refer to Tricare approved diagnosis list.

Our forms are in Adobe Acrobat PDF format. You can download Adobe free at the following link.