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Complete Patient Registration Information

Patient First Name

Patient Last Name

Patient Date of Birth*

(Must be at least 5 years of age.)

Patient Sex

Patient Email Patient/Parent or Guardian Email

Patient Phone

Has the patient received a liver transplant?*
(The Genomind PGx test may not be appropriate if the patient has received a liver transplant)

Yes No

Enter Patient's Shipping Address

Please provide the patient’s shipping address below. This is where the test kit will be sent.

Must be a U.S. address.
Test is not available in Nevada.
PO Boxes are not accepted.

Country: United States of America

Shipping Address

Zip Code

City

State

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Enter Medications (optional)

We highly recommend you enter your current medications. This helps our test identify potential genetic interactions and provide tailored recommendations—so you can get the most out of your results!

Current Medications

To search for a medication, type the first 3 letters in the name of the medication to see a list of available options. Select the medication from the dropdown list.
Enter only one current medication per entry box. Only medications that are evaluated on Genomind reports can be added.
Use the [+]/[-] buttons to add or remove medications

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Make your payment

Please select how you would like to pay for your test. You must agree to the terms below before making a payment.

By checking this box and completing your purchase, you agree to Genomind's Terms & Conditions and Privacy Policy, as well as PWNHealth's Terms of Services and Genetic Testing Consent.