{"id":1227,"date":"2026-03-04T11:17:00","date_gmt":"2026-03-04T11:17:00","guid":{"rendered":"https:\/\/services.nhslothian.scot\/geneticservice\/?page_id=1227"},"modified":"2026-03-04T11:38:43","modified_gmt":"2026-03-04T11:38:43","slug":"request-forms","status":"publish","type":"page","link":"https:\/\/services.nhslothian.scot\/geneticservice\/request-forms\/","title":{"rendered":"Request Forms"},"content":{"rendered":"\n<p class=\"has-regular-font-size\"><a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/Genetic-Test-request-v9-1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Genetic Testing Request Form<\/a><\/p>\n\n\n\n<p><strong>Prenatal Testing<\/strong> (Amniotic fluid and CVS): <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/Prenatal-Referral-V9.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Prenatal Genetic Test Request Form<\/a><\/p>\n\n\n\n<p><strong>Pregnancy loss\/solid tissue&nbsp;samples<\/strong>: (send sample to Pathology who will forward a suitable aliquot): <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/Tissue-Referral-v9.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Solid Tissue Referral Form <\/a><\/p>\n\n\n\n<p><strong>Oncology samples&nbsp;<\/strong>(bone marrow, peripheral blood and tumour): <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/GENE-WC241-Oncology-request-form.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Oncology Cytogenetics&nbsp;Referral Form <\/a><\/p>\n\n\n<style>.wp-block-kadence-spacer.kt-block-spacer-1227_3c0087-3a .kt-block-spacer{height:20px;}.wp-block-kadence-spacer.kt-block-spacer-1227_3c0087-3a .kt-divider{border-top-width:1px;height:1px;border-top-color:#eee;width:80%;border-top-style:solid;}<\/style>\n<div class=\"wp-block-kadence-spacer aligncenter kt-block-spacer-1227_3c0087-3a\"><div class=\"kt-block-spacer kt-block-spacer-halign-center\"><hr class=\"kt-divider\" \/><\/div><\/div>\n\n\n<div class=\"gb-container gb-container-9b370d8e\">\n\n<h3 class=\"wp-block-heading has-standard-white-background-color has-background has-regular-font-size\" style=\"padding-top:0;padding-right:0;padding-bottom:0;padding-left:0;font-style:normal;font-weight:800;text-transform:none\">Disease-specific forms (last reviewed March 2026): <\/h3>\n\n<\/div>\n\n\n<p><\/p>\n\n\n\n<p>Mainstream gene panel testing for inherited cardiac conditions: <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2025\/08\/GENE-WM470-Cardiac-panel-referral-proforma.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">ICC panel test request form (Affected Patients Only)<\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Mainstream gene panel testing for&nbsp;breast cancer&nbsp;patients:&nbsp; <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/BRCA-v5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Breast panel genetic test request&nbsp;form (Affected patients)<\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Polyposis&nbsp;(including juvenile polyposis syndrome),&nbsp;colorectal cancer,&nbsp;Lynch syndrome&nbsp;or&nbsp;Peutz-Jegher syndrome: <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/Colorectal-cancer-gene-panel-proforma-v8.docx\" target=\"_blank\" rel=\"noreferrer noopener\">CRC gene panel referral proforma.docx&nbsp;<\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Hereditary Spastic Paraplegia: <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/Hereditary-Spastic-Paraplegia-HSP-Referral-Proforma-v1.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Hereditary Spastic Paraplegia (HSP) referral proforma<\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Haemophilia and Thrombosis&nbsp;Genetics: <a href=\"https:\/\/services.nhslothian.scot\/geneticservice\/wp-content\/uploads\/sites\/54\/2022\/08\/Molecular-Haematology-Request-Form-GENE-WM273_v3.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Molecular Haematology request form<\/a><\/p>\n\n\n<style>.wp-block-kadence-spacer.kt-block-spacer-1227_624ee8-a8 .kt-block-spacer{height:60px;}.wp-block-kadence-spacer.kt-block-spacer-1227_624ee8-a8 .kt-divider{border-top-width:1px;height:1px;border-top-color:#eee;width:80%;border-top-style:solid;}<\/style>\n<div class=\"wp-block-kadence-spacer aligncenter kt-block-spacer-1227_624ee8-a8\"><div class=\"kt-block-spacer kt-block-spacer-halign-center\"><hr class=\"kt-divider\" \/><\/div><\/div>\n\n\n\n<p><\/p>\n\n\n\n<p>To keep waste to a minimum please print copies of the forms as you need them.&nbsp;&nbsp;Please regularly check this site for the latest version.&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Genetic Testing Request Form Prenatal Testing (Amniotic fluid and CVS): Prenatal Genetic Test Request Form Pregnancy loss\/solid tissue&nbsp;samples: (send sample to Pathology who will forward a suitable aliquot): Solid Tissue Referral Form Oncology samples&nbsp;(bone marrow, peripheral blood and tumour): Oncology Cytogenetics&nbsp;Referral Form Disease-specific forms (last reviewed March 2026): Mainstream gene panel testing for inherited cardiac<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":28,"comment_status":"closed","ping_status":"closed","template":"page-templates\/widewidth.php","meta":{"footnotes":""},"categories":[],"class_list":["post-1227","page","type-page","status-publish","hentry"],"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/services.nhslothian.scot\/geneticservice\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"Genetic Testing Request Form Prenatal Testing (Amniotic fluid and CVS): Prenatal Genetic Test Request Form Pregnancy loss\/solid tissue&nbsp;samples: (send sample to Pathology who will forward a suitable aliquot): Solid Tissue Referral Form Oncology samples&nbsp;(bone marrow, peripheral blood and tumour): Oncology Cytogenetics&nbsp;Referral Form Disease-specific forms (last reviewed March 2026): Mainstream gene panel testing for inherited cardiac","_links":{"self":[{"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/pages\/1227","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/comments?post=1227"}],"version-history":[{"count":11,"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/pages\/1227\/revisions"}],"predecessor-version":[{"id":1509,"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/pages\/1227\/revisions\/1509"}],"wp:attachment":[{"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/media?parent=1227"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/services.nhslothian.scot\/geneticservice\/wp-json\/wp\/v2\/categories?post=1227"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}