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  This form is directly submitted online

This form is directly submitted online

1.  Name

1. Name


2.  Are you still available? Describe your availability.

2. Are you still available? Describe your availability.


3.  E-mail contact information

3. E-mail contact information


4.  Affiliation(s)

4. Affiliation(s)

Please list your current affiliation(s).  Your information is strictly confidential and will not be supplied to anyone.

5.  Current licensure status

5. Current licensure status

List all states in which you currently are licensed.  Also any for which you have licensure pending or for which you are in process.

6.  Do you carry Professional Liability Insurance? Valid till ?

6. Do you carry Professional Liability Insurance? Valid till ?


7.  Times That I am Available

7. Times That I am Available

We have 4 hour shifts from 8 a.m. to 1 p.m., 12 p.m. to 4 p.m. and 4 p.m. to 8 p.m.  Monday through Friday.  Would  you be interested in any of these? 

8.  Late Evening Shifts and Weekends

8. Late Evening Shifts and Weekends

Please indicate your interest in late evening shifts: 8 p.m. to midnight,  midnight to 4 a.m., 4 a.m. to 8 a.m.  
Also, would you be interested in on-call evening or weekend hours-- for responding to phone inquiries for  4, 8, or 12 hour shifts?  

9.  Expertise and Interest

9. Expertise and Interest

Please tell us about your areas of expertise. Could you describe your availability for Prenatal, Cancer, Cardiac, Neurogenetic, etc.  based on your experience, expertise or  interest.   

10.  Optional

10. Optional

You may send us your resume, if updated, or if you have not yet sent it to us at  info@geneticcounselingservices.com.  
If you wish to be considered for an assignment for summer/fall 2015 please supply the name of at least one reference at this time.  

11.  Message/ Questions/ Comments

11. Message/ Questions/ Comments


12.  Verifier

12. Verifier

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Discussions with a genetic counselor as offered by Genetic Laboratories and Genetic Testing Companies serve to provide key information for the understanding of genetic testing, although pedigree intake and record review may be focused to the results of genetic testing.  Although laboratory license and permit and genetic counselor certification and licensure where applicable, do not permit the practice of medicine, genetic counselors can provide explanation and direction to physicians and authorized medical professionals for the interpretation of the results of genetic testing.  Genetic counselors, upon physician waiver and in collaboration with ordering clinicians, can provide counseling on genetic testing and the meaning of test results. Comprehensive genetic counseling may be available through physicians who can provide genetic counseling within the scope of their practices as they choose and through genetic counselors within the scope of their practice. Please note that patient management and genetic counseling surrounding on-going prenatal or any diagnostic testing is best handled by Physicians, Maternal/Fetal and Pediatric Genetics specialists,  in conjunction with clinical services where they are available and in collaboration with genetic counselors and other genetic specialists. 

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info@geneticcounselingservices.com