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Department of Genetics Heersink School of Medicine

Collection Kit Request

1. Requesting Provider Information

Please provide the following information for the healthcare provider requesting the collection kit. Collection kits are available only to authorized healthcare providers and their affiliated practices. 

Please enter the requestor's name.
Please enter the requestor's professional title.
Please enter the facility name.
Please enter a valid email address for the requesting party.
Please enter a valid phone number.
Please enter the facility's street address.
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Please enter the city.
Please enter the state, province, or region.
Enter a valid postal code.
Please select a country.
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Shipment Tracking
Shipment Tracking
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2. Shipping Information

Where should we ship the collection kit?

Ship the collection kit to:(*)
Ship the collection kit to:
Please select where the collection kit should be shipped.

Alternate Shipping Address

Please complete this section only if the collection kit should be shipped to a different address than the requesting provider.

Please enter the name of the individual receiving the kit.
If applicable, please enter the facility name for where the kit is being shipped.
Please enter a valid email address for who is receiving the kit.
Please enter a valid phone number for the individual receiving the kit.
Please enter the street address for where the kit is being shipped.
Invalid entry.
Please enter a valid city.
Please enter a valid State / Province / Region.
Please enter a valid postal code.
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If other, please specify country.

3. Kit Request Details

Please select the collection kit needed and complete the information below to fulfill your request. 

Please select a kit type.
Blood Collection Kit - Prior Approval Required

Blood collection kits are intended for situations in which collection supplies are not otherwise available. Because most laboratories routinely stock 4 cc EDTA tubes, blood collection kits are provided only with prior approval from the UAB Medical Genomics Laboratory.

Biopsy Media Requirements

Prior discussion with the UAB Medical Genomics Laboratory is required before requesting biopsy media.

  • Biopsy media should be requested at least one week before the scheduled procedure to allow adequate shipping time.
  • Biopsy media expires approximately 2–3 weeks after shipment.
  • Each biopsy media kit contains three collection tubes.
Please select the quantity requested.

Note: Requests for multiple kits may require review or approval by the UAB Medical Genomics Laboratory prior to shipment.

4. Additional Request Information

Please provide any additional information needed to process your collection kit request.

Enter a valid requested delivery date.
Please enter a valid procedure date.
Include a prepaid return shipping label with the kit?(*)
Include a prepaid return shipping label with the kit?
Please select one.
Will a completed test requisition accompany the specimen?(*)
Will a completed test requisition accompany the specimen?
Please indicate whether a completed test requisition will accompany the specimen.
Test Requisition Required

A completed test requisition is required before testing can be performed.

If you have not already completed one, please download the blank test requisition .

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5. Patient Information

Patient information helps us associate your kit request with an existing or upcoming test order. If a patient has not yet been identified, this field may be left blank.

Enter valid patient information.
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Submit Kit Request