Contact Form for Providers
Contact Form for Corporate Directors
Schedule or Cancel Your Appointment Here
Self-Pay and Co-Payment (not required for Preventative)
Corporate Request Contact Form
Schedule a Meeting to Discuss your Organizational Needs
For Genetic Counselors
Update to Professional Interest Form
Clients without computer access may contact us by phone at 888-260-6543
2. Name of Individual Making Request:
3. For whom are you requesting that genetic research be done?
(e.g. self, organization, physician, medical personnel, supervisor)
What is the address of your facility? At what address or location will patients be located at such time that you anticipate they speak with a genetic counselor through our service?
5. Details of Request
Please specify whether you are requesting service for patients at the time of appointment with your center, prior to the time of appointment or afterwards, and other details of encounter or contact which are important to know.
6. What is most important to you?
Please describe what you envision from a remote service. What would be the perfect arrangment for your needs?
7. What types of patients, tests or conditions are involved?
Feel free to explain anything about your service that it would be helpful to know.
8. What other options are you considering to meet your needs?
Please discuss any other considerations you have for satisfying your staffing needs. We can sometimes help you to budget by working with a point person from your center who may already be involved in your clinical processes. If possible, please provide any general budget information here. In doing so, we can be sure to include such in a program that does not exceed or fall short of your actual needs.
9. When do you need a service to START?
Also, please describe your current situation of Genetics or medical professionals who work in your clinic.
What do you anticipate to be the role of our service with regards to any genetic testing coordination? Is plebotomy and genetic test coordination available at your center directly?
10. Please provide your contact information
Email and Phone number
What documentation will you require on patients that we service? If you have any form or letter 'type' that your clinic or service now uses, please feel free to fax (1-888-204-5975) or email to 1-888-260-6543.
We will try to respond to all inquiries with useful information within one week
of receipt of this form. Thank you for your consideration of Genetic Counseling Services
For security purposes, we ask that you enter the security code that is shown in the graphic. Please enter the code exactly as it is shown in the graphic.
Copyright © Genetic Counseling Services Schenectady, New York