Forms and templates

The easiest way to submit a Test Requisition Form (TRF) is through our online portal. Alternatively, a PDF version of the TRF is available below and can be submitted along with the patient sample or via fax: (520) 626-2808.
Please let us know if you have additional questions 
email: PANDAcore@arizona.edu, phone (520) 626-9807, fax (520) 626-2808

Genome, Exome, and Panels Test Forms

Test Requisition Form (consent form included)

Consent Form (necessary for online submission)

Specimen requirements

 

Insurance Forms

Prior Authorization Request Form