Igenomix Genetic Counseling for PGT-A (PGS)
Personal information
Choose your session
First Name
Last Name
Email
Are you
Please select...
The registered patient at your clinic
The partner of the registered patient
Other
Patient's Date of Birth (MM/DD/YYYY)
Your phone
Campaign ID
Clinical information
Patient's name
(as it should appear on the summary letter that will be sent to your physician)
Clinic name
Clinic City / Location
Clinic State
Physician
Have you had carrier screening?
Please select...
Yes, and my results indicated that there is a high reproductive risk
Yes, and my results indicated that there is a low reproductive risk
I'm not sure
No, I declined carrier screening
No, but I plan to have carrier screening
Have you experienced pregnancy loss?
Please select...
Yes
No
Will this be your first IVF cycle with PGT-A testing?
Please select...
Yes
I have done IVF previously, but not with PGT-A
I have done IVF with PGT-A previously
Will you be using an egg or sperm donor?
Please select...
No
Yes, an egg donor
Yes, a sperm donor
Yes, an egg and a sperm donor
What testing are you pursuing at Igenomix?
Please select...
PGT-A only
PGT-A and PGT-M
PGT-SR (includes PGT-A)
I'm not sure
By registering for this Igenomix webinar, you are authorizing Igenomix to communicate with your fertility center, as indicated on the registration, regarding but not limited to your registration information, attendance, and information provided during the webinar.