Order Form

Examination

Tumor Mutational Burden (TMB)

You have to be a Physician to order this test.

Patient Information

Full Name: *

Father's Name: *

Gender: *

Male

Female

Sender: *

Phone: *

Mobile: *

Address: *

City: *

Country: *

Postal Code: *

Id Number: *

Date of Birth: *

Email:

Sample Information

A. The sample that was sent to Genekor is:

Blood

ID:

Paraffin Block

ID:

Paraffin Sections

ID:

Other

ID:

B. Date of sampling:

Clinical- Historical Data

Clinical / Histological diagnosis

Comments

Physician

Full Name: *

Phone: *

Speciality: *

Hospital: *

Address: *

Email:

Fax:

Send copy to:

Sample pick up *

Full Name: *

Phone: *

Mobile: *

Address: *

City: *

Postal Code: *

Pick Up Day(except Weekends): *

Pick Up Time (09:00-17:00): *

Pay by card (debit or credit)

Pay in the offices

AcceptOrder Form Terms

SUBMIT

Portal

HerediGENE

BRCA Test

PrIMe

Mo.Re.

Com.Pl.i.t DX Assay

OncotypeDX

MyTheragene

Cordis DX

CerebrumDX®

Tumor Mutational Burden (TMB)

Microsatellite Instability (MSI)

PD-L1

PCA3

Single Genes

MyThrombogene

iGenome

Signatera

RediScore®

About

Our Team

Publications

Order Form

Examination

Tumor Mutational Burden (TMB)

You have to be a Physician to order this test.

Patient Information

Sample Information

Clinical- Historical Data

Comments

Physician

Sample pick up *