Igenomix form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the PATIENT INFORMATION section. Enter the last name, first name, middle name, and birthdate for both the patient and their partner. Ensure all fields are completed accurately.
3. Next, move to the CLINIC INFORMATION section. Provide the name of the IVF clinic, referring physician's name, signature, primary nurse's name, and an email address for sending genetic counseling notes.
4. In the OPTIONAL INFORMATION section, indicate the REASON FOR GENETIC COUNSELING REFERRAL by selecting one or more options provided. You can also specify any questions or topics you wish to discuss.
5. Fill out the REASON FOR ERA TESTING section by selecting from options like Implantation Failure or Endometrial Study. Include any relevant clinical data regarding ERA Cycle type and pregnancy history.
6. Finally, if you would like an ERA specialist to reach out for further discussion, provide a contact phone number in the designated field.

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