Carrier Screening Requisition for Providers  

Laboratory Test(s) Being Ordered


















Partner Information




Specimen Requirements
  • Blood: One 5-10 mL ACD tube (yellow top) and two 5-10 mL EDTA tubes (lavender top)
  • Saliva: Saliva specimens are accepted in Oragene DNA (OG-500) kits by DNA Genotek. Please note that Tay Sachs enzyme analysis cannot be performed on saliva












eg. John Smith, MD