Clinical Questionnaire for Prenatal Molecular Genetics Testing

This form should be completed when prenatal molecular genetic testing is ordered on amniotic fluid, cultured amniocytes, chorionic villi, or cultured villi. The form should be completed by the ordering physician's office and should accompany the sample. Also, the completed form can be faxed to our genetic services department at 888-287-8199. Please call 800-345-4363 and ask to speak to a genetic counselor with any questions.