NGS Service Request Form

1. Customer Information

Provide the primary contact responsible for the request.

Organization

Department

Contact name

Email

Telephone

Customer or account number

Billing address

Purchase order number

Quote number

2. Project and Requested Services

Select all requested services and provide a concise project summary.

Requested NGS services

Whole-exome sequencingTargeted gene panelsRNA sequencingTranscriptome sequencing

Project title

Study, protocol, or project ID

Organism or species

Reference genome

Project objective

Whole-Exome Sequencing

Analysis type

Requested mean coverage

Number of matched pairs or trios

Targeted Gene Panel

Panel name or application

Requested mean coverage

Genes, regions, or supplied design

RNA and Transcriptome Sequencing

Application

Library selection

Requested reads per sample

3. Deliverables and Analysis

Select all requested outputs. Final scope and pricing are confirmed during review.

Requested deliverables

Raw FASTQ filesBAM and VCF filesBioinformatics analysis reportData interpretation consultation

Preferred pipeline or software

Additional file formats

Analysis, filtering, annotation, or reporting requirements

4. Sample Information

Add one record for each submitted sample. Use coded identifiers only.

5. Shipping and Data Delivery

Planned shipment date

Carrier

Tracking number

Shipping condition

Requested turnaround

Preferred data delivery

Shipping, handling, or data-transfer notes

6. Customer Authorization

The submitting customer must review and accept the statements below.

I certify that the information is accurate and the submitted materials are authorized for testing.I certify that the submission contains no direct patient identifiers.I have disclosed all known biological hazards, infectious agents, recombinant materials, and special handling requirements.

Authorized name

Title

Date

Electronic signature

7. Laboratory Use Only

Accession or project number

Date received

Received by

Condition on receipt

Sample acceptance

Technical review

Laboratory notes

Item added to your cart

Next-Generation Sequencing Service Request