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Specialized Testing for Rare Genetic Disorders

Forms and Certificates

Click on the links below for access to printable forms.

Forms

  • Medicare ABN Form
  • Consent Form
  • Financial Responsibility Form
  • New York State Informed Consent for Genetic Testing Form
  • Specimen Collection and Shipping Information
  • Test Requisition Form
  • W9 Form

Certificates

  • CLIA Certification
  • New York State Clinical Laboratory Permit
 

Quick Links

  • About Our Lab
  • Testing Methods
  • Targeted Variant Analysis
  • Genetic Awareness Panel (GAP)
  • Custom Panels
  • Chromosomal Microarray
  • How to Order Tests
  • Specimen Collection, Handling, and Shipping
  • Forms and Certificates
  • Billing Information

DDC Clinic (OH)


14567 Madison Rd
Middlefield, OH 44062

440-632-1668
info@ddcclinic.org

LAB SERVICES
440-632-5532
lab@ddcclinic.org

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DDC Clinic (PA)


150 West Central Ave. Suite 1
Titusville, PA 16354

814-376-1424
PAinfo@ddcclinic.org

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