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OPTION #1 |
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OPTION #2 |
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Paperwork Option |
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Thyroid Profile 5™ & DNA |
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OFA Thyroid Expanded Profile & DNA |
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Submit Existing Complete Thyroid Panels done within the past 6 months |
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$102 $80 to Hemopet |
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$126 $106 to Hemopet + $15 to OFA |
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Cost of photo-copying |
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Cost of Overnight Shipping |
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Cost of Overnight Shipping |
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Cost of Postage |
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Cost of Collection & Prep |
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Cost of Collection & Prep |
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Also Enclose: |
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Also Enclose: |
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Also Enclose: |
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IWS Questionnaire |
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IWS Questionnaire |
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IWS Questionnaire |
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(Supporting Data) * |
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(Supporting Data) * |
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(Supporting Data) * |
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(Pedigree) * |
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(Pedigree) * |
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(Pedigree) * |
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Test Request Form |
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Test Request Form |
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DNA Informed Consent |
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DNA Informed Consent |
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App. for OFA Thyroid Database § |
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For Thyroid–Serum to Submit: |
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For Thyroid–Serum to Submit: |
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SEPARATED SERUM from ONE (1) full RTT(red top) tube of blood |
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SEPARATED SERUM from TWO (2) full RTT(red top) tube of blood |
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For DNA–Whole Blood to Submit: |
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For DNA–Whole Blood to Submit: |
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TWO (2) full LTT (lavender top) tubes filled with WHOLE BLOOD |
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TWO (2) full LTT (lavender top) tubes filled with WHOLE BLOOD |
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If From Outside US: |
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If From Outside US: |
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Explanatory Letter for US Customs |
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Explanatory Letter for US Customs |
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 = Required Information
§Requires registration numbers |
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