Asper-Biotech-sample-submission-form by lsy121925

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									Sample Submission to Asper Biotech

 Investigator
 Organization
 Date of shipment
                                                Genotyping service         Genotyping service         Diagnostic
 Tests required                                 Standard delivery*         Express delivery**         package***
                                                Number of samples          Number of samples          Number of samples

 Sensorineural Hearing Loss
 Cystic Fibrosis
 Thalassemia
 Wilson Disease
 Ashkenazi Jewish diseases
 Hereditary Breast and Ovarian Cancer
 Microsatellite instability
 Familial Adenomatous Polyposis
 Hereditary Nonpolyposis Colorectal
 Cancer/Lynch Syndrome
 Venous Thrombosis risk assessment
 ApoE genotyping
 Thiopurine S-Methyltransferase
 deficiency
 Resistance to norovirus infections
 Lactose Intolerance
                                                Person
 Delivery confirmation to
                                                Email address
                                                Person
 Results to be sent to                          Email address
                                                Phone
                                                Person
 Invoicing information
                                                Email address
                                                Address

                                                VAT account
 In EU countries please add paying              number
 institution's VAT account number,
 otherwise 20% of VAT tax will be               Phone
 added to the invoice.
                                                PO Number

 Invoice delivery                                   By e-mail                    By regular mail
By submitting DNA samples to Asper Biotech the client agrees that invoices shall be paid within 10 calendar days as of the
invoice date and in case of delay in the payment, the open invoice amounts will accrue interest amounting to 0,1 % per
calendar day.



                             ASPER BIOTECH Ltd • reg Nº 10504931 • Vaksali 17A, 50410 Tartu, Estonia
                          phone +372 7307 295 • fax +372 7307 298 • info@asperbio.com • www.asperbio.com
* - Genotyping service (standard delivery)
    Genotyping
    Electronical copy of the results report
    The results will be delivered by 3-6 weeks
For more detailed information of turnaround times look at
http://www.asperbio.com/genetic-testing-process/turnaround-times

** - Genotyping service (express delivery)
     Genotyping
     Electronical copy of the results report
     The results will be delivered by 7 working days
The cost of the express delivery differs from the standard delivery.

*** - Diagnostic package
      DNA extraction
      Genotyping
      Additional validation of the APEX-based analysis findings by dideoxy sequencing
      Interpretation
      Hard copy of the interpretation report
      The report will be delivered by 3-6 weeks
For diagnostic package download interpretation order form www.asperbio.com, in addition to current
sample submission form. Fill in the forms and send them both with samples.

NOTE: Interpretation order form is needed only for diagnostic package.


Supportive services for genotyping
      DNA extraction from blood (35 €)
      DNA extraction from saliva (27 €)
      Additional validation of the APEX-based analysis findings by dideoxy sequencing
      (Applied Biosystems 3130 Genetic Analyzer). 29 € per mutation.
      Hard copy of the genotyping results (23 €)
      Remained DNA will be sent back by courier (95 €) to the
      address.............................................................................................................................................
      Remained DNA will be sent back by postal parcel (95 €) to the
      address.............................................................................................................................................

Following information is required for successful processing of samples

               Sample code                                                                                   Comments / Patient’s data
                                                              DNA concentration
     (samples should be pre-coded                                                                           (fill the field if patient’s data is
                                                             (preferred 100-250 ng/µl)
         when sent to Asper)                                                                              needed for reporting and invoicing)




 COMMENTS



Important: The testing and interpretation of DNA analyses are based on the current understanding of the
molecular genetics and basis for these conditions. DNA-based testing is highly accurate but due to
variations on the biological level rare errors may occur. A negative result for any of the conditions tested
cannot eliminate the possibility that the individual carries a mutation not determined by the test. By
submitting DNA samples and orders to Asper Biotech the client has agreed to use the DNA-test results
and interpretations at its own responsibility and to indemnify, hold harmless and defend Asper Biotech
from any claims which may arise due to any errors.
                              ASPER BIOTECH Ltd • reg Nº 10504931 • Vaksali 17A, 50410 Tartu, Estonia
                           phone +372 7307 295 • fax +372 7307 298 • info@asperbio.com • www.asperbio.com

								
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