Laboratory for Molecular Diagnostics
Center for Nephrology and Metabolic Disorders
Moldiag Diseases Genes Support Contact

On our website we offer a web-based step-by-step assistant to compose and submit those forms automatically. This page offers the classical alternative: downloading, filling out, and sending along with the sample.

The following forms are required

Signed consent form

A signed consent form is required for all genetic tests performed in Germany. Consent form is not required if samples of dead individuals are tested. For genetic tests in the context of scientific studies a permission of a national board of scientists or some ethics committee is required to. Consent Form

It is not necessary to use our consent form. It is even not necessary to send a copy of those approvals if the referring scientists gives written testimony of its existence and storage.

Payment approval

  • In case of private billing we need a document confirming the payment.
  • In case of institutional billing an official approval is required

We did intentionally not create a form for this approval. Please use the official letter from your institution to declare that your institution is prepared to pay for the test.

The following forms are also helpful

Order form

This form gathers information about patient's identity, referring physician, and to whom report and invoice have to be sent. If this information is provided by your institution's order form it is fine with us. Order Form

Clinical survey form

Clinical data are helpful if interpreting the results. Unless our for is used, any clinical reports and laboratory workups are welcome. Clinical Survey Form

Pro forma invoice

For customers from outside the European Union, a proforma invoice is helpful to avoid delay at customs. Pro Forma Invoice
Copyright © 2005-2021 by Center for Nephrology and Metabolic Disorders, Dr. Mato Nagel, MD
Albert-Schweitzer-Ring 32, D-02943 Weißwasser, Germany, Tel.: +49-3576-287922, Fax: +49-3576-287944
Sitemap | Webmail | Disclaimer | Privacy Issues | Website Credits