OncoPrism-HNSCC Requisition Form

Complete and fax this form to Cofactor Genomics at +1 (844) 328-5841 to order OncoPrism-HNSCC.

Please include with the fax to Cofactor Genomics:

1- Front and back of the patient’s insurance card(s)

2- Physician's order for OncoPrism-HNSCC laboratory testing

Please also fax the requisition form to your appropriate location-specific pathology contact, if applicable, to avoid processing delays.

Additional instructions for ordering OncoPrism-HNSCC can be found here.