Collection Kit Request Form
Your kit request and/or test requisition request has been received by Revvity Omics. If you have any questions, please call us at 1-866-354-2910 or email us at genomics@revvity.com.

If you would like to submit another request for kits, please click here.
This form should be used to request test kits and test requisitions be sent to a health care provider’s office. Additionally, this form is intended for our standard clinical genomic testing menu and service.
If you would like to request test kits or requisitions for one of our Sponsored No-Cost Testing Programs (i.e. the Lantern Project, ASAH1 Gene Testing, or PPMD Testing Program), please click here.
Who is Kit Being Sent to?
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Test Requisition Form Version (select all that apply)
Contact Information
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