Order submission

Order Form Patients

The Patient is

The Patient is

Patient's details

Patient's details

Sender's details

Send invoice to the same address?

Send invoice to the same address?

Billing's details

Billing's details

Sample type

Clinical information

Please give as much clinical info as possible.

Did you already have a genetic counselling?

Did you already have a genetic counselling?

Genetic counseling data

Fill out the fields below. Please note that the final medical report will be sent in c/c to your physician/genetic counsellor
Doctor's Name
Doctor's Name
First
Last
Maximum upload size: 20MB
[optional]

Genetic counselling service

Genetic counselling service

To proceeed with the order, you must get the online consultation with one of our Medical Geneticists before and after the test. Our Medical Genetists will explain you the results and will finally send you a formal written genetic counselling. We'll apply a 90 euro of fee for the genetic counselling service: 90,00 €

Select your WEXOME

Select your WEXOME

WEXOME TRIO

Additional options

PHARMACOGENOMICS PROFILE - 39€

ClinVar

ClinVar submissions *
Can we submit selected genetic variants from this sample to ClinVar?
ClinVar is the largest, non-profit human mutation database. It's aimed to help improving clinical interpretation of any genetic lab. ClinVar submissions are completely anonymzed and do not include any personal patient's or sender's data. Learn more.

Summary

€
Payment
You'll receive an email with all details for the bank transfer. The payment must be received in full before the order starts (i.e. before the filter cards or the swab can be sent to your address).

Summary of requested analysis

Order number