Get 855 509 4909

Completing the 855 509 4909 form is essential for initiating your genetic testing process. This guide provides clear and supportive instructions on how to accurately fill out each section of the form online to ensure there are no delays in your testing.

Follow the steps to effectively complete the 855 509 4909 form.

1. Click ‘Get Form’ button to access the document and open it for editing.
2. Begin by entering your client account number in the designated field. Ensure this number is accurate, as it helps identify your account within the system.
3. Fill in the client name and the patient's information, including name, date of birth, and phone number. Double-check these details to avoid any discrepancies.
4. Select the patient's ethnicity by checking all applicable boxes. Refer to the ethnicity chart if necessary to ensure an accurate representation.
5. In the patient history section, if the patient has a history of cancer, provide details including previous genetic testing and cancer types by selecting 'Yes' and entering the required information.
6. If applicable, input the age of diagnosis for cancer types listed and indicate whether the patient has any current diagnoses related to hematological malignancies.
7. Answer the questions regarding family history of BRCA or other gene mutations. If 'Yes,' make sure to provide and submit any required test reports.
8. In the patient family history section, check the box if there is no known family history of cancer. Otherwise, fill in the relationship, cancer location, age of diagnosis, and whether living or deceased.
9. Complete the patient acknowledgment section by signing and dating the form, allowing Quest Diagnostics to process the information as needed.
10. After thoroughly reviewing all entered information, save your changes. Download or print the form for submission during the patient's blood draw.

Complete your 855 509 4909 form online to ensure a smooth and timely testing experience.