First Name (required)

Last Name (required)

Your Phone (required)

Kit Ordered (required)
—Please choose an option—Hereditary Cancer TestingAlzheimer's Genetic Predisposition TestingAcid Reflux and Antiemetics Drug MetabolismAnti-Seizure Drug MetabolismCardiac Drug MetabolismPain Drug MetabolismPlavix Drug MetabolismPhychiatry and Addiction Drug MetabolismWarfarin Drug Metabolism

Unique Kit ID Located on the requisition form inside your kit (required)

I understand that this kit requires physician authorization. My physician or primary health care provider will authorize and sign the the requisition form in the kit.

Your Date of Birth (required)

Biological Sex (required)
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Ancestry (required)
CaucasianAfrican AmericanAsianHispanicOther

Street Address (required)

City (required)

State (required) Sorry, cannot be registered in CA, NY, MD —Please choose an option—ALAKAZARCOCTDEFLGAHIIDILINIAKSKYLAMEMAMIMNMSMOMTNENVNHNJNMNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY
Zip Code (required)

Your Email (required)

I understand that incomplete forms or forms without a physician details or signature may lead to delay in processing or rejection of the sample.

I understand that it is my responsibility to read the collection and shipping guidelines prior to taking the test.