UT Genetics Center

Laboratory Requisition Forms

• Molecular Diagnostic Laboratory Requisition Form (.doc)
  
  
• Biochemical Diagnostic Laboratory Requisition Form (.doc)
  
  
• Cytogenetic Diagnostic Laboratory Requisition Form (.doc)
  
  
• Hematology/Oncology Laboratory Requisition Form (.doc)

Neurological: Presymptomatic Testing Consent form(.doc)

Neurological: Diagnostic Testing Consent Form (.doc)

Other Helpful Documents

• Pediatric/Prenatal/Adult Referral Form
  
  
• Oncology Referral Form
  
  

• CPT Coding Information (.doc)
  
  
• Clinical Laboratory Improvement Amendments Certificate
  (CLIA Certificate) (.pdf)

The University of Tennessee Graduate School of Medicine

Department of Medical Genetics/ UT Genetics Center
UT Graduate School of Medicine
Building A, Suite 435
1930 Alcoa Highway
Knoxville, Tennessee 37920
Phone: 865.305.9030 
Toll free: 1.800.325.3894
Fax: 865.305.6675

 

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