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OPTION #1 |
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OPTION #2 |
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OPTION #3 |
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OPTION #4 |
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Submit Existing Thyroid Panels |
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Thyroid Analysis (Thyroid Ab Profile/D8T + TgAA) |
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Thyroid Analysis & DNA (Thyroid Ab Profile/D8T + TgAA) |
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Thyroid Analysis, DNA & OFA Panel # 86135 + DNA<) |
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Cost of photo-copying |
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$55.00 $35.00 to Hemopet |
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$55.00 $35.00 to Hemopet |
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$85.00 $65.00 to Hemopet |
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$15.00 to OFA |
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Cost of Postage |
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Cost of Shipping |
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Cost of Shipping |
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Cost of Shipping |
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Cost of Collection & Prep (?) |
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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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Also Enclose : |
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IWS Questionnaire |
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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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(Supporting Data) * |
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(Pedigree) * |
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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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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 # www.offa.org/thyappbw.pdf |
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Thyroid Test Requirements: |
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Thyroid Test Requirements: |
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Thyroid Test Requirements: |
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SEPARATED SERUM from ONE (1) full RTT(red top) tube of blood |
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SEPARATED SERUM from ONE (1) full RTT(red top) tube of blood |
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SEPARATED SERUM from ONE (1) full RTT(red top) tube of blood |
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DNA Test Requirements: |
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DNA Test Requirments: |
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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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If From Outside US: |
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Explanatory Testing Letter for US Customs |
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Explanatory Testing Letter for US Customs |
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Explanatory Testing Letter for US Customs |
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* = Optional information |
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# = Requires registration numbers |
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