Take the next step with GeneSight^® Testing

Fill out your information below to take a step closer to getting the GeneSight test or registering to provide the test to your patients. We will follow up with additional information either via email or phone in regards to the GeneSight test.

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Take the Next Step - PD

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Please provide us with your name

First Name

Last Name

I Am A...

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Please provide contact and clinic information

Please provide contact information

Date of Birth (MM/DD/YYYY)

We are asking for Date of Birth for data verification purposes.

Job Title

Zip Code

Phone

Would you like to provide the patient's information?

Relationship to Patient

Patient First Name

Patient Last Name

Patient Zip Code

Patient Date of Birth (MM/DD/YYYY)

We are asking for Date of Birth for data verification purposes.

Are you interested in us contacting the patients' clinician about GeneSight?

If you do not have a clinician, we have a directory of healthcare providers who are registered to order the GeneSight test. When you complete this form, we will link you to this directory, so you will have the option to view registered GeneSight providers in your area.

Patient's Doctor's First Name

Patient's Doctor's Last Name

Patient's Clinic Name

Patient's Clinic Zip

Patient's Clinic Phone

Referring a Clinician to Order?

Your clinician who is currently managing your medication and making treatment decisions can order your GeneSight test.

Please provide your clinician's information

The GeneSight test must be ordered by your clinician

NPI

Clinic Name

Clinic Phone

Clinic Zip

Would you like to provide information for the prescribing clinician?

Prescribing Clinician NPI

Prescribing Clinician First Name

Prescribing Clinician Last Name

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How can we help?

When completed, we'll follow up with more information

Please let us know how we can best help you

When completed, we'll follow up with more information

How Can We Help You?

If you are a patient or a caregiver and would like to request a copy of your results, please complete the Patient Report Request form here

How Can We Help You?

Additional Details

Do you live in the United States?

We would love to communicate with you about our programs, products, and services. We will always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Your consent may be withdrawn at any time using the unsubscribe link provided in all of Myriad’s email communications.

Yes please, I would like to hear about programs, products, and services. No thanks, I do not want to hear about programs, products, and services.

How can we help?

Contact Information

By submitting your information in this form, you agree that your personal information may be stored and processed in any country where we have facilities or service providers, and by using our “Take the Next Step” page you agree to the possible transfer of information to countries outside of your country of residence, including to the United States, which may provide for different data protection rules than in your country. The information you submit will be utilized for the sole purpose it was submitted for and governed by our Privacy Notice.