Genetic Test Request & Consent

Please select the relevant genetic test or consent form from the list below. Once a selection is made, the corresponding form will be displayed automatically. Kindly ensure that all information is completed accurately and that the consent sections are reviewed carefully before submission. These forms are required to proceed with genetic testing and related laboratory procedures.

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I would like to take this test for Huntington’s disease diagnosis. I have been informed that the gene responsible for Huntington’s disease is located on the 4th chromosome. It was explained that this disease is a triplet repeat (CAG) expansion mutation. I understand that if there is an increase in the number of these triplet repeat sequences, there is a risk of developing Huntington’s disease depending on the number of repeats. This blood test will determine the number of CAG repeats in my Huntington’s gene. I. I understood that I would encounter 4 possible outcomes as a result of this test; 1. NEGATIVE: The CAG repeat count is within normal limits (26 repeats or fewer). This person is not at risk for Huntington’s disease and will not pass the disease on to their child. 2. NORMAL/MUTATION: The CAG repeat number is within the normal/mutation range (27-35). The individual does not exhibit the disease, but their children are at risk. 3. INTERMEDIATE: CAG repeat count is in the intermediate range (36-39 repeats). Although it is not known for certain whether the disease will manifest at some point in this person’s life, there is a risk. 4. POSITIVE: The CAG repeat count is within the Huntington’s disease range (40 repeats or more). This person will develop the disease at some point in their life. A neurological evaluation is required for the initial symptoms of the disease. II. One of the most significant challenges of this test is psychological. Results in the intermediate range are difficult to interpret and cause difficulties in determining the risk status. II. Individuals with a family history of Huntington’s disease but who do not yet exhibit any symptoms are considered “asymptomatic” individuals. Considering the psychological risks, the standard testing procedure for Huntington’s disease involves testing symptomatic individuals or asymptomatic adults who have received adequate counseling. IV. All information related to the test will be stored securely. Test results will be sent only to the relevant physician from the laboratory and will be disclosed only to me. I have been informed about the possibilities related to the test program and I consent to the presymptomatic test. I have been informed about the risks and benefits of the test, the difficulties encountered when evaluating the results, and the possible psychological effects of the results.I AgreeI Disagree

Genetic Test Request & Consent

Patient Information

Patient Information

Prenatal Diagnosis Test – Patient Information

Physician Information