Order PGx Testing Kits

Getting started is quick, simple and easy

The Advanced Genetics Lab PGx assay assessment platform is available for licensed prescribing clinicians. To request a test kit, please provide the information below and we will process your order. If you have an urgent issue, please call us at (475) 988-7011.

KIT INFO, CLINICIAN AND ADDRESS DETAILS

Number of Kits

Please indicate how many kits you would like

Physician Name

Physician ordering test requisition

First Name

Last Name

Practice Name

Name of Medical Group

Practice Specialty

Specialty medical services provided

NPI #

Physician NPI Number

Email Address

Phone

Practice phone number

(###)

###

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Fax

Practice fax number

(###)

###

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Address

Practice address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Message

How Did You Hear About Us?

Clinical Referral

Patient Referral

Website

Conference