Forms

All specimens sent to the Center must accompany a completed Test Request Form. For autopsy cases, the Autopsy Consent and Testing and Reporting Policies Forms must be completed and submitted to the Center along with clinical history/medical records of the patient. Delays in reporting may result without this information.
Some of the forms on this page are in Adobe PDF format. You will need the Adobe Acrobat Reader. You may download this reader for free by clicking on the icon to the right. If you have questions, please contact us at 216-368-0587 or cjdsurv@case.edu

Autopsy Consent This form needs to be completed if you would like us to coordinate an autopsy. Printable PDF Document Click Here Testing and Reporting / Genetics Consent This form must be completed whenever blood or frozen brain tissue is sent to our Center in order to release genetic results. Printable PDF Document Click Here

Test Request This form must be completed with all samples submitted to the Center. The Center is fully compliant with HIPAA regulations. Printable PDF Document Click Here Cerebrospinal Fluid and Biopsy Billing Requisition This form must be completed ONLY when sending cerebrospinal fluid or biopsy tissue to our Center for testing and we are to bill patient directly. Printable PDF Document Click Here