Genetic Test Kit Inquiry Form Your Name(Required) First Last Your Email Address(Required) Are You Requesting a Genetic Test Kit for Yourself or Someone Else?(Required)For MeFor Someone ElseTheir Name(Required) First Last Their Age(Required) Their Date of Birth(Required) MM slash DD slash YYYY Your Relationship(Required) What symptoms are you/they experiencing? Enlarged spleen Chronic low platelet count Bleeding and clotting problems Bone infarction or avascular necrosis (AVN) Bone pain and bone crisis Early onset osteopenia and osteoporosis Spontaneous fractures Delayed growth Do you/they have a family member already diagnosed with Gaucher disease?NoYesNot SureIf yes, who? Do you know their gene mutation? Are they on ERT? Do you/they have a family member with Parkinson's?NoYesNot SureIf yes, who? How Did You Hear About Us?For example, from a friend, referral, advertisement, other website, etc.Next StepsAfter submission of your inquiry, you will be contacted by Dr. Robin Ely, NGF Founder and Clinical Director. Δ
