Interested in ordering a test or becoming a provider? Register below and our team will be in touch. First Name* Last Name* Email* Phone* Company/Clinic Name* Region* —Please choose an option—United StatesAustraliaOther Are you a/an?* —Please choose an option—An EnterpriseA Healthcare ProviderA Consumer/PatientAn InvestorA Partner What segment best represents your enterprise?* —Please choose an option—Employee Wellbeing/Wellness VendorsWorksite Health CentersEmployer Healthcare CoalitionsEBC/BrokerNutraceutical/Supplement IndustrySelf-Insured EmployersPayor ASOsOther Type of provider* —Please choose an option—Functional/Integrative MedicineConcierge MedicineOB/GYNPrimary CareImaging CenterSurgeryGenetic CounselorOncologyAcademic Medical Center/High Risk Women’s Health CenterAcademic Precision Medicine Program What do you want to do?* —Please choose an option—I want to set up a geneType provider accountI want follow upOther Address* City* State* Zip/Post Code* Fax Number Main Office Contact Name* (This person will be the designated account holder for your geneType physician portal where you order tests and receive results) Main Office Contact Email* Ordering Licensed Provider Name* (GeneType can only be ordered by a healthcare provider) NPI#* Ordering Licensed Provider Email* (If the provider wants to be notified of report delivery, we need their email) What type of office implementation process are you interested in?* I have a cash-pay practice and I am interested in wholesale pricing options to incorporate into my offeringI don’t want to deal with billing and I am interested in geneType billing my patient directly (self pay) How do you want to offer geneType, through telehealth or in office visits?* Interested in having geneType drop shipping to my patient once I submit the orderInterested in having kits in office on consignment to use during consultations I’d prefer to be contacted by: —Please choose an option—PhoneEmail I’d prefer to be contacted during: —Please choose an option—MorningAfternoonEvening I’d like to talk to: —Please choose an option—SalesMedical AffairsOrdering Assistance/Lab QuestionsTechnical HelpBilling What do you want to do?* I want to order a test through a telehealth providerI want more information to talk to my doctorQuestions about billingOther Preferred Clinic* (If you don’t have a clinic, please write "N/A") Comments GeneType is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you: I agree to receive other communications from GeneType In order to provide you the content requested, we need to store and process your personal data. If you consent to us storing your personal data for this purpose, please tick the checkbox below. I agree to allow GeneType to store and process my personal data* You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy. For consultants ONLY: Consultant Name: Δ About About Us Investors Contact Our Brands GeneType For Individuals Breast Cancer Test Colorectal Cancer Test Ovarian Cancer Test Prostate Cancer Test Coronary Cancer Test Type 2 Diabetes Multi-Risk Test Atrial Fibrillation Test Melanoma Test Pancreatic Test For Medical Practitioners Breast Cancer Test Colorectal Cancer Test Ovarian Cancer Test Prostate Cancer Test Coronary Cancer Test Type 2 Diabetes Multi-Risk Test Atrial Fibrillation Test Melanoma Test Pancreatic Test © Rhythm Biosciences FollowFollow
