Tumour BRCA test request forms

If you would like to access the AstraZeneca/MSD's tumour BRCA testing service for an eligible patient please download one of the forms below.

Note, there are differences to the forms based on laboratory requirements (e.g. information about sample, details of where to send sample), so please ensure they are completed correctly for the laboratory of choice.These forms can be filled in electronically. Please fill in all sections. Once complete, print off and include with the sample that is sent to the lab. Please note there are two pages to this form. The lab will require both pages to be FULLY completed, printed and sent with the sample.