Request forms

Contact the secretariat of the lab for more information: 0032-9-332 2477

For genetic tests the following information is required:

• Identification data of the applying doctor and of other doctors who would like to receive a copy of the result report (name and other information such as registration number with the Belgian Institute of Health and Disability Insurance (RIZIV), specialties, address, phone number)
• Application date
• Date on which the sample is taken, if different than the application date
• Two informative items on the patient which are also to be indicated on the sample container for identification: e.g. full name and date of birth
  • If the newborn’s name is not known yet, the baby’s last name and date of birth could be used for identification purposes, as well as a code, e.g. ‘XX’ instead of the first name.
  • For foetal samples the following identification is used: ‘foetus of (mother’s name)’ or ‘child of (mother’s name)’.
• Information on patient’s medical insurance
• Clinical information
• Requested genetic test:
  • On our application forms, you can simply mark the genetic condition you are applying the test for. Information on the sample required for that particular test can be found on our website.
  • If you wish a genetic test which is not listed on the application form you can choose for 'Andere' and you mention the test you apply for. We will try to find out the opportunities. There might be additional conditions, or genetic testing might not be possible or useful. We will inform you as soon as possible.

Moreover, for the interpretation of the test result it is important to know the indication for the genetic test.

Examples:

• your patient has clinical signs, and you are applying for genetic testing to confirm or exclude a clinical diagnoses
• your patient has a brother or a sister with an autosomal recessive hereditary condition and you would like to know if your patient is a carrier