Request forms

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, 263 KB)
• 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