Useful Forms

Clinical Referral Forms

• Urgent referrals to the genetics clinic
• Consent Form for Assessment by a Clinical Geneticist (patient deceased)
• Consent to access records and stored samples form
• Key Social Worker form
• Family history of cancer form
• NF1 clinical proforma
• NF2 clinical proforma

Laboratory Referral Forms:

• Genetic testing-related forms — link to the North West GLH website
• Specialist cell culture service referral form — for referral to the Specialist cell culture service
• The Willink Metabolic Unit referral form — for biochemical genetics testing
• The Willink Metabolic Unit Handbook

Additional forms:

• Request for genetic cystic fibrosis carrier testing — to be used by General Practitioners requesting cystic fibrosis carrier testing.
• Export Request Form (Molecular Genetics Testing) — required for all samples which need to be exported to other laboratories for molecular genetic testing.
• UKGTN Female Fragile X Request Form
• UKGTN Male Fragile X Request Form
• HD consent form — required for all samples referred for diagnostic testing of Huntington Disease. Presymptomatic tests should be referred through a Genetics Centre.
• NF1 clinical proforma — required for all samples received for mutation screening of the NF1 gene
• NF2 clinical proforma — required for all samples received for mutation screening of the NF2 gene
• Rare disease form — required for samples referred to the rare disease service