DNA analysis request form - University College London Hospitals 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's surname and forename(s) in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the date of birth, gender, and address. For gender, tick the appropriate box. This information helps in categorizing the sample correctly.
4. Provide details about the GP and any genetic investigations in the family. If applicable, list names, relationships, and dates of birth of relatives.
5. Complete sections for hospital number, NHS number, referring hospital, and consultant's name. These details are essential for tracking and processing.
6. Indicate the priority level (urgent or routine) and provide an email address for report delivery (NHS.NET only).
7. Select the sample type and category by ticking the relevant boxes. Include any additional information regarding extraction methods if DNA is being submitted.
8. Ensure that you sign the consent statement confirming that you have obtained patient consent for testing and storage before submitting.

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