Submit the completed form to the appropriate recipient as instructed by Invitae. For US submissions, email clientservices@invitae.com, fax to 415-276-4164, or mail to Headquarters & Laboratory, 1400 16th Street, San Francisco, CA 94103. For submissions outside the US, contact globalsupport@invitae.com or visit www.invitae.com/contact for further information. Ensure you keep a copy of the completed form for your records.

There are no specific important dates associated with this form for 2024 and 2025.

The purpose of this form is to provide informed consent for genetic testing. It outlines the potential outcomes and implications of the testing, including the possibility of discovering genetic conditions, carrier status, or risk factors. Additionally, it ensures that the patient understands their rights and responsibilities, and it requires the signature of both the patient and healthcare provider.

• 1. Patient signature: The signature of the patient providing consent for the genetic test.
• 2. Date: The date the patient signs the form.
• 3. Patient name: The printed name of the patient.
• 4. Email address: The patient's email address.
• 5. Signature of parent/guardian: The signature of the parent or guardian if the patient is a minor.
• 6. Parent's/guardian's name: The printed name of the parent or guardian.
• 7. Healthcare provider signature: The signature of the referring physician or healthcare professional.
• 8. Healthcare provider date: The date the healthcare provider signs the form.

Failure to submit this form may result in the inability to proceed with genetic testing. It may also delay diagnosis and relevant medical management.

• Inability to Proceed with Testing: Genetic testing cannot be conducted without the proper consent form.
• Delayed Diagnosis: Without testing, a potential diagnosis may be delayed, impacting medical treatment.
• Missed Risk Assessment: Failure to submit the form means missing out on crucial information regarding genetic risk factors.

• 1. Undergoing Genetic Testing: Complete this form to provide consent for genetic testing.
• 2. Testing Minors: Parents or guardians must complete this form for minors.
• 3. Consulting Genetic Counselors: Consult a genetic counselor and provide consent using this form.
• 4. Healthcare Provider Facilitation: Healthcare providers use this form to facilitate patient testing.
• 5. Research Studies: Researchers conducting genetic studies require this form for participant consent.