Order Antegenes tests

Recipient:
OÜ Antegenes
Reg. nr. 14489312
Licence: L04685
Address: Raatuse 77, Tartu 50603
Phone: +372 5377 8141
E-mail: info@antegenes.com

Doctor's information:

Doctor (Name, doctor's code)

National identification number

Medical institution / company

Medical institution / company address

Phone

E-mail

⠀

Patient information:

First name

Family name

National identification number

Date of birth

Nationality

Address

Phone

E-mail

Barcode number

⠀
malefemale
⠀

⠀

Select tests:

AnteBC (polygenic risk score test of breast cancer)AntePC (polygenic risk score test of prostate cancer)AnteCRC (polygenic risk score test of colorectal cancer)AnteMEL (polygenic risk score test of melanoma)

*The customer orders marked test(s) for the patient as a laboratory test of OÜ Antegenes on the basis of in vitro medical device regulation.
The patient has given signed informed consent to perform the ordered test(s)
The patient is aware of the testing process, the transfer of his/her data to the Antegenes company, the opening of his/her case at Antegenes and agrees to the Antegenes general terms and conditions of use and privacy

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