Non-Invasive Prenatal Test (NIPT)

1 Checklist

2 Your Details

3 Find Centres

4 Review & Confirm

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.
I am ready to make payment by credit card.*
- I am ready to make payment by credit card.
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*
Email * Confirm Email *
Mobile Number*
Confirm Mobile Number*
Postcode for Preferred Collection Centre*

STEP THREE

Find Centres
Find your nearest collection centre
The Generation NIPT test is available at many Collection Centres Australia-wide. If you have trouble locating a suitable collection centre, please contact Genomic Diagnostics on 1800 822 999 so that we can help you.
Please note:
Public holidays may influence standard operating hours. If your selected date falls in close proximity to a public holiday please contact the collection centre on the phone number provided to confirm availability.
Your location
Your nearest collection centres

Selected collection centre
Collection Centre 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.
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Payment information:
Credit Card

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$ 0.00
Comments
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