Request forms must be legible (it is possible to type the information into the available PDFs) and provide:
- patient's full name
- date of birth and NHS / hospital number
- patient's postcode
- name and address for invoicing for non-NHS referrals
- full name and address of referring clinician
- referral reason and test/s required
- information regarding any known or suspected infection risks (e.g. HIV / Hep B & C / TB) must be clearly documented
Request forms
- Oxford Genetics Laboratories joint request form (pdf, 317 KB)
- Request form for cytogenetic studies on oncology/solid tumour samples (pdf, 236 KB)
- Inherited Coagulation Bleeding, Thrombotic and Platelet Disorders Request Form (pdf, 334 KB)
- Disorders of Iron Regulation Request Form (pdf, 272 KB)
- Molecular Haematological Oncology Testing Request Form (pdf, 363 KB)
- Solid Tumour Molecular Diagnostics Request Form (pdf, 465 KB)
- Genotyping of Haemoglobin Disorders Request Form (pdf, 439 KB)
- Prenatal Diagnosis of Haemoglobin Disorders Request Form (pdf, 377 KB)
- Rare Disease in Molecular Haematology Testing Service Genomic Panel Request Form (pdf, 402 KB)
- Breast, Ovarian and Prostate Cancer Request Form (pdf, 361 KB)
Pre-request forms
- Calcium disorders testing request form (pdf, 300 KB)
- Familial hypoparathyroidism testing request form (pdf, 240 KB)
- Genetic Diagnostic and Advisory Service for Mitochondrial Diseases Request Form (pdf, 352 KB)
- Microsatellite Instability (MSI) / Methylation Analysis Tumour Profiling Request Form (pdf, 291 KB)
- Familial Hypercholesterolaemia (R134) Genetic Testing Request Form (pdf, 263KB)
- Endocrine Neoplasia R217 Request Form (pdf, 190 KB)
Whole Genome Sequencing (WGS)
Referral forms and sample requirements for whole genome sequencing are available on the following website:
West Midlands Regional Genetics Laboratory
Specific queries about WGS
Email: bwc.centralsouthglh@nhs.net
