Travera RTG EarlyAccess

Travera Rapid Therapy Selection™

TEST REQUISITION FORM
Is this a de-identfied sample?*

Yes, I will enter Unique Sample IDNo, I will enter Patient Information
By submitting this form I attest that I am an authorized provider, or am completing this form as a representative of an authorized provider. As may be required by applicable state laws and regulations, the patient has been informed regarding Travera’s testing and has consented for the test to be ordered. The patient has been informed that the result of their test will be interpreted as only one element in the medical decision-making process driven by their care team, and that those same results may be used or published by Travera in a deidentified manner in a manner that demonstrates the test’s performance characteristics.
For questions, please email: info@travera.com

Travera Rapid Therapy Selection™