Amplexa Genetics A/S
Sverigesgade 24, st.
DK-5000 Odense C,
Denmark
Tel. +45 66 11 66 28
Opening hours: Mon-Fri: 9:00-15:00
CVR nr. 29428441
info@amplexa.com
Bank Name: Danske Bank
SWIFT: DABADKKK
For payment in DKK:
Reg. nr.: 3596 Account nr.: 3362237343
IBAN: DK1230003362237343
For payment in EURO:
Reg. nr.: 3596 Account nr.: 3600085980
IBAN: DK4030003600085980
LABORATORY REQUISITION FORM: MOLECULAR GENETIC TESTING
REQUISITION/ORDER FORM
An electronic version of the form is sent to the email provided under “Requester”, print it and included it with your sample.
You can add additional information (e.g. pedigree) on the hard copy if needed.
You can expect a Turn-around Time (TAT) 5-6 weeks
OBLIGATORY INFORMED CONSENT:
By ordering an analysis at Amplexa Genetics A/S, the requester confirms to have obtained the necessary informed consent for the performance of the requested analyses, and accepts Amplexa Terms and Conditions. A hard-copy requisition or an e-mail stating the specific analysis together with the receipt of a sample is considered an order to conduct the analysis.
* Fields are required, ** Required only one of them
Vi gemmer ikke dine personlige data
Betingelser
I de tre nævnte pakker undersøges udelukkende for allerede kendte sygdomsfremkaldende varianter hos testpersonen. Varianterne er omtalt i Human Genome Mutation Database (HGMD) og publiceret i videnskabelige tidsskrifter.
Amplexa Genetics A/S
Sverigesgade 24, st.
DK-5000 Odense C,
Denmark
Tel. +45 66 11 66 28
Opening hours: Mon-Fri: 9:00-15:00
CVR nr. 29428441
info@amplexa.com
Bank Name: Danske Bank
SWIFT: DABADKKK
For payment in DKK:
Reg. nr.: 3596 Account nr.: 36003362237343
IBAN: DK1230003362237343
For payment in EURO:
Reg. nr.: 3596 Account nr.: 3600085980
IBAN: DK4030003600085980