Order

Please kindly fullfil the bold datas.

PapaGen

Personal data


Title		Street:
Name:		Town:
Surname:		POSTAL CODE:
Tel.:		Fax:
E-Mail:		Ethnic:
Sex:
Language:		Language of the final report
Date of birth:		in form DD.MM.YYYY
kw: rodne_cislo:
kw: pojistovna:

Personal data second person


Title		Street:
Name:		Town:
Surname:		POSTAL CODE:
Tel.:		Fax:
E-Mail:		Ethnic:
Date of birth:		in form DD.MM.YYYY

Personal data third person


Title		Street:
Name:		Town:
Surname:		POSTAL CODE:
Tel.:		Fax:
E-Mail:		Ethnic:
Date of birth:		in form DD.MM.YYYY

Address for correspondence


Title		Street:
Name:		Town:
Surname:		POSTAL CODE:
Tel.:		E-Mail:
kw: odber-vzorku:

Complete if the address is different from the client's address

Address to be stated on the invoice


Firma:		Street:
Name:		Town:
Surname:		POSTAL CODE:
Tel.:		Id. No.:
Fax:		Tax ID:
E-Mail:		kw: cislo_uctu:

Complete if the address is different from the client's address

Legal representative


Title		Street:
Name:		Town:
Surname:		POSTAL CODE:

* please complete if the person who will be examined is less than 18 years old

Method of payment


	Cash at the cash desk of GHC GENETICS, Krakovská 8/581, Praha 1
	Card on-line
	Bank transfer
	Postal money order to the GHC GENETICS account

Note

DECLARATION • GHC Genetics is obliged to ensure confidentiality with regard to all received data, and all provided data will be handled in accordance with the Act on Personal Data Protection no. 101/2000 Coll., as amended by related laws. • GHC Genetics is obliged to use the samples exclusively for the purposes of the genetic analysis that was ordered by the client and to ensure that these samples will be protected against abuse.

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E-Mail:

Password:

REGISTRATION

Clinic GHC in Prague

Genetic predispositions are not a destiny but a scientifically discoverable reality. The effect of genes can be affected and a responsible person uses the results of a genetic test for his own benefit.

HEREDITARY PROPERTIES OF GENES

GENETIC MUTATIONS

PREDICTIVE GENETICS

PERSONALIZED MEDICINE

GLOSSARY