Referral Form

Please refer to our Sample Requirements section before sending any samples to us for testing. The section for each tumour type links to the

relevant test request form. The relevant forms can also be found below:

Genetic Tumour Testing Request Form

 

 

Deceased Index Request Form

 

 

Whole Genome Sequencing

 

 

Plasma DNA (cfDNA) Mutation Testing in NSCLC

Please use this form for the following tests:

• Non Small Cell Lung Cancer – ctDNA (pdf)
• Non Small Cell Lung Canrte – ctDNA (Word)

 

Request for CNS Tumour Testing Form

Please use this form for the following tests:

• Central Nervous Systems Tumours (pdf)
• Central Nervous Systems Tumours (Word)

 

Request for Sarcoma FISH (Liverpool referrers only)

Please use this form for sarcoma FISH requests from Liverpool referrers:

• Liverpool Referral form (pdf)

Request for MLH1 hypermethylation analysis (Liverpool referrers only)

Please use this form for MLH1 promotor methylation analysis (Liverpool referrers only):

• Liverpool MLH1 hypermethylation request (pdf)

HRD and Tumour BRCA test request form for Ovarian Cancer

 

FFPE CRC pro-forma