Impact Genetics > Order A Test > Order a Retinoblastoma (RB) Test > RB Forms

Retinoblastoma Test Order Forms

Please complete the required forms with each RB sample sent to our lab.

You can download the individual forms below, or get all forms & instructions in one PDF document by downloading the RB Submission Package from the Downloads side bar.

Individual Forms

1a. Informed Consent for Genetic Testing (English)
1a. (New York State Only) RB Test Informed Consent Form
1a. Consentement éclairé à des tests génétiques (French)
1a. RB test Consentimiento Informado (Spanish)
1b. RB Test Requisition Form
1d. Credit Card Authorization for Non-Covered Services Form

Please follow the sample preparation and shipping instructions.

 

◀ How to Order a Retinoblastoma Test    ||    Retinoblastoma Sample Preparation ►

Downloads
RB Test Submission Package
RB Test Description
RB Test Sample Report – Uni Germline
Buccal Swab Collection Instructions
Buccal Swab Patient Information Form