Pre Counselling | Pangenia Lifesciences

Pre Counselling

One-Stop Solution

Our consultation service includes diagnosis, disease progression monitoring and medical advice from genetic counselors & multiple discipline specialists. We could base on each patient’s needs to design and provide a tailored solution.

Make an Appointment for Consultation
To make an appointment, please fill out the following form and click “Submit.”
The information will be sent to the Pangenia Center of Excellence customer service team.
They will contact you to obtain additional information and assist in selecting the appropriate services to meet your requirements.

Please Note: We have two types of platform for patients to choose, either Face To Face platform or Remote Online Platform. We will advise how the appointment will be delivered and provide easy instructions for all appointments.

Please complete this section for the individual to be seen

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Name *

Telephone *

Email *

Product Category *

Available Time for Calling *

Additional Information

Year of Disease

Year of Diagnosis / Methods of Diagnosis

Hospital Visited

Clinical Diagnosis

Other Disease Information

Genetic Tests have been done (Please Explain Below)

Other Clinical Assessment have been done (Please Explain Below)

Family History of the Disease(s)

Upload Medical Record (Submit by PDF Format)

Files in your bin will be automatically deleted after 30 days

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Disclaimer
Your use of this form constitutes your agreement to the terms of our privacy policy. If you are concerned about sharing protected health information, please call us, and do not enter the information here.
Your email address will never be shared with third parties.

***PLEASE ONLY SUBMIT THIS FORM ONE TIME.
***You will receive an email confirmation of your appointment request.