Prefer it online? Patients fill it out on their phone before the visit.
Practice name: ______________________________
Genetic Testing Consent Form
Your information
Patient Name *
Date of Birth
____ / ____ / ________
Test Type & Indication
Scope of Testing Explained
Potential Results & Limitations
Secondary Findings Preference
Family Implications Acknowledged
Additional details
Genetic Privacy & GINA Rights
Specimen Storage & Biobanking Consent
Research Data Sharing Consent
Genetic Counseling Acknowledgment
Right to Withdraw Consent
Your practice's consent wording goes here.
Signature
Date
Patient Signature
Date
Ordering Provider Signature
Date
Genetic Testing Consent Form template from formisoft.com. formisoft.com/intake-templates/genetic-testing-consent