Non-Invasive Prenatal Test (NIPT)

1Checklist

2Your Details

3Payment

Non-Invasive Prenatal Testing

STEP ONE

Select Test

Please confirm each of the following in order to proceed
My NIPT request form has been fully completed by my referring Doctor.*
- My NIPT request form has been fully completed by my referring Doctor.
My referring Doctor has signed the request form.*
- My referring Doctor has signed the request form.
I have read the Patient Consent and have signed the request form.*
- I have read the Patient Consent and have signed the request form.
I will be at least 10 weeks gestation at the time of visiting the collection centre.*
- I will be at least 10 weeks gestation at the time of visiting the collection centre.
By selecting my test below, I consent to pay the correct amount for the test option selected by my doctor as indicated on my Generation request form.*
- By selecting my test below, I consent to pay the correct amount for the test option selected by my doctor as indicated on my Generation request form.
Choose which test*

STEP TWO

Your Details
One-off Individual Code
Please enter individual code if applicable. If not, please leave this blank.
Name*
First Name * Last Name *
Date of Birth*
Address*
Street Address Street Address Line 2 Suburb State Postcode
Email*
Phone*

STEP FOUR

Review & Confirmation

Please confirm all details are accurate and true to the best of your knowledge. If you wish to change any of these details, please use the ‘Edit Previous Step’ button below.
{all_fields}
Payment information:
Credit Card

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$ 0.00
Comments
This field is for validation purposes and should be left unchanged.

*NIPT referrals that are not equivalent to available Generation options may be refused

Non-Invasive Prenatal Testing