Follow the steps to successfully complete your PGT requisition form.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Enter patient information in the designated fields, including their last and first names, address, city, phone numbers, date of birth (DOB), and the last four digits of their Social Security Number (SSN). Repeat the same for the partner.
3. Fill in the egg donor and sperm donor details if applicable, including their dates of birth and identification numbers.
4. In the biopsy/transfer/batching details section, specify relevant parameters such as biopsy type, transfer type, and any batching requests. Include cycle information and the relevant embryo number.
5. In the setup/test request section, select applicable tests such as aneuploidy (PGT-A), single gene disorder (PGT-M), or HLA matching (PGT-HLA). Provide additional details regarding the testing strategy if necessary.
6. Confirm cycle information, specifying tentative and confirmed dates where required. Also note the diagnosis/symptoms, stimulation start, hCG, retrieval, biopsy, and transfer/freeze information.
7. Complete the IVF center information, including the name, address, and contact details of the referring physician and nurse/coordinator.
8. Select billing preferences, indicating whether the billing is directed to the patient or a center, and specify any applicable insurance.
9. Indicate reporting preferences, specifying how you wish to receive the results of the test.
10. Ensure to have the physician sign the form. Save your changes, download the completed form, and then email it to info@rgiscience.com or fax it to 847-400-1516 prior to the stimulation start date.

Complete your IL RGI PGT requisition form online now to ensure timely processing and testing.