LRNA Testing Program: Intake Form

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We Value Your Privacy

At CTOAM, your privacy is one of our highest priorities. We understand the sensitivity of the personal and health-related information you share with us, and we are committed to protecting it with the utmost care and integrity.

All information collected through our forms and services is handled in strict accordance with British Columbia’s Personal Information Protection Act (PIPA). We use secure, encrypted systems to store and manage data, and we limit access to our privacy-compliant clinical team members.

Your information will never be shared without your explicit consent and will only be used for the purposes clearly outlined in our communications.

You can trust that your data is safe, confidential, and treated with the same respect we offer in every aspect of our care.
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What is the reason you want the LRNAdx Liquid Biopsy?* This field is required.Please select the option that applies to you most.
I wonder if I have cancer and want to know for sure.
I have been diagnosed with cancer and want to confirm the diagnosis is correct.
I want to gain more information about the staging of my cancer, level of aggression, and treatment options.
I am currently on treatment and want to monitor how well the treatment is working.
I have been told my cancer is gone and want to confirm that's really true.
I am currently in remission and want to check for recurrence.
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We’re here to take care of the details and help you get the answers you need, as quickly and smoothly as possible.

To ensure we can help you effectively, we’ve prepared a few brief questions. Please answer them as best you can.

If you’d prefer to speak with someone directly at any point, our medical office team is here for you. Just call 1-778-999-5463 ext. 0. We’re happy to help.
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Step 1
Complete this short form. Your answers will help us understand your imaging needs so we can connect you with the most appropriate program and location. When you're done, just click Submit.

Step 2
Within 24 to 48 business hours (Monday to Friday), a member of our care team will call you for a brief consultation. This helps us better understand how we can support you.

Step 3
We'll arrange for a test kit to be shipped to your home and for a laboratory technician to visit you to collect two vials of blood for testing. The lab tech with contact you to schedule this house-visit.

Step 4
Your blood sample will be shipped to our Next-Generation Sequencing Lab in Vancouver, BC, Canada. Our team will perform the first part of the process –including exosome separation and RNA isolation, purification and conversion to cDNA – to prepare for sequencing.

Step 5
Our lab team will use our state-of-the-art genetic sequencing technology to identify if molecular features involved in active cancer processes (i.e. metastasis) are present in your body – and, if so, to what extent and which markers are driving your cancer.

Step 6
Within three weeks of our lab receiving your sample, your results will be presented to you in a detailed and easy-to-understand report.

Step 7
If your results indicate cancer activity, and/or you would like to discuss new treatment options, we offer a Complete Treatment Options Review consultation with our Molecular Analysis and Medical Genetics Team (additional fees apply).

Please go ahead and complete the intake form to get started.

We’re here to support you every step of the way.
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Your Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
Confirm Email
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Phone number* This field is required.Area code and phone number.
Example: +1 (250) 845-1294
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Is this LRNAdx Liquid Biopsy for you?* This field is required.
YESNO
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If the LRNAdx Liquid Biopsy is not for you, please write the patient's name:
First Name
Last Name
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Where do you currently live? (City and Country)* This field is required.
Example: Vancouver, British Columbia, Canada
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Are you a cancer patient, caregiver / family member, or healthcare provider?* This field is required.Select the option that best describes you.
Cancer patient
Healthcare provider
Caregiver / family member
Other
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Date of birth (Day, Month, Year)* This field is required.
Example: 12 April, 1956
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Please select which best applies to you:For medical health purposes, it is helpful for us to know this information.
Woman
Man
Intersex
MtF Female
FtM Male
Prefer not to say
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Please select your preferred pronouns:
She / her / hers
He / him / his
They / them / theirs
Ze / hir / hirs
Prefer not to say
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Weight and height?* This field is required.
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Which address should we send your test kit to?* This field is required.We will be sending your test kit via FedEx.
Please include: Your house or apartment number, street, city, postal code, province, country, and any other relevant info.
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Which address should the nurse come to do the blood draw?* This field is required.If it's the same address as where to send your test kit, please write "same".
Please include: Your house or apartment number, street, city, province, postal code, country, and any other relevant information.
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Are you currently on treatment?
Yes
No
Unsure
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What treatment are you on (name) and what cycle are you on?* This field is required.
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Please tell us your preferred method of follow-up communication:
Phone call
Email
Text message (SMS)
Unsure
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How did you hear about us?* This field is required.Please select an option below:
Doctor or healthcare professional
Friend or family
Patient support group
Social media (Facebook, Instagram, LinkedIn, Twitter)
YouTube video
'Cancer: Just the Facts' online program
Google Search
Not sure
Other
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Is there anything else you would like to share with us?
Huge
Large
Normal
Small
Ok
Ok
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Please give us permission to email you about your LRNAdx Liquid Biopsy needs and cancer care.* This field is required.
Yes, you may email me about my LRNA testing needs and cancer care.
No, you may not email me about my LRNA testing needs and cancer care.
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Consent for Collection, Use, and Storage of Personal Information: * This field is required.I understand that the personal and health-related information I provide in this form, including any uploaded documents, is being collected by CTOAM for the purpose of providing LRNAdx Liquid Biopsy testing coordination and related cancer care support.
I agree and give my informed consent.
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Click SUBMIT to Continue Booking

After you click "Submit", you’ll receive a phone call from our team within 24 to 48 business hours (Monday to Friday 7am to 5pm Pacific Time).

After speaking with you, we will start your LRNAdx Liquid Biopsy Testing Program.

If you would like to speak with someone before that, please call our medical office team at 1-778-999-5463 ext. 0.

We're here to guide and support you every step of the way. We look forward to speaking with you very soon.

Please click SUBMIT
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