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  • Credit Card Authorization Form - Invitae

Get Credit Card Authorization Form - Invitae

Credit Card Authorization Form FM1057 Please complete and provide a copy of this form in the Specimen Collection Kit. All information will remain confidential and will be used solely for the purpose.

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How to fill out the Credit Card Authorization Form - Invitae online

Filling out the Credit Card Authorization Form is an essential step for processing your payment with Invitae. This guide will provide you with clear and concise instructions to help you complete the form accurately and securely online.

Follow the steps to successfully complete your authorization form.

  1. Press the ‘Get Form’ button to access the Credit Card Authorization Form and open it in your preferred online editor.
  2. Enter the cardholder name in the designated field. This should be the name as it appears on the credit card.
  3. Provide your signature in the assigned area to authorize the payment.
  4. Fill in the date when you are completing the form.
  5. Input the billing address associated with the credit card. Make sure the address is accurate to avoid payment issues.
  6. Enter your email address in the required field; this is necessary for confirmation and communication purposes.
  7. Optionally, provide your phone number for additional contact if needed.
  8. Select the credit card type from the available options: Visa, MasterCard, AmEx, JCB, or Discover.
  9. Input your credit card number exactly as it appears on the card.
  10. Indicate the expiration date of your credit card in the required format.
  11. Provide the card identification number, which is the three-digit code typically located on the back of your credit card.
  12. Specify the amount to charge by selecting the appropriate option based on the services requested or entering a custom amount.
  13. Review all the entered information for accuracy before finalizing the form.
  14. Once you are satisfied with the information provided, save changes, download, print, or share the completed form as necessary.

Begin your document submission online today to ensure your services are processed promptly.

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How much do Invitae's proactive health tests cost? Within the US, both the Invitae Cancer Screen and Invitae Cardio Screen are $250. The Genetic Health Screen, which includes all genes analyzed in the Cancer and Cardio Screen, is $350. We do not accept health insurance for our proactive screens.

How long does it take to get my results? Once Invitae receives your sample, on average your healthcare provider will receive the results in: Diagnostic panel testing: 10-21 calendar days. STAT panel testing: 5-12 calendar days (7 days on average)

Once you have received a completed NIPT request form from your doctor, you will need to book and pay for your NIPT. This can be done by using the Sonic Genetics payment portal.

Patient pay Patients may also pay by visiting .invitae.com/self-pay at any point after the order has been placed. Invitae's patient assistance program is not available for proactive health screen orders, but Invitae offers a payment plan to help make testing more affordable.

Register using a confirmation code If you did not receive an email, but you have a patient card with a confirmation code, go to .invitae.com/patients and click Register Your Test to create your account and register your test. If you already have an account, sign in and click Register a test .

Invitae is a College of American Pathologists (CAP)-accredited and Clinical Laboratory Improvement Amendments (CLIA)-certified clinical diagnostic laboratory.

How long does it take to get my results? Once Invitae receives your sample, on average your healthcare provider will receive the results in: Diagnostic panel testing: 10-21 calendar days. STAT panel testing: 5-12 calendar days (7 days on average)

How much do Invitae's proactive health tests cost? Within the US, both the Invitae Cancer Screen and Invitae Cardio Screen are $250. The Genetic Health Screen, which includes all genes analyzed in the Cancer and Cardio Screen, is $350. We do not accept health insurance for our proactive screens.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232