LRNA Testing Program: Intake Form

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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.

Complete the form below to begin the L-RNA blood-based exosomal RNA molecular profiling process.

L-RNA is intended to provide supplemental molecular profiling information and should be considered alongside clinical history, standard investigations, imaging, pathology, and physician evaluation.

When you're done, just click Submit.

Step 2
Within 24 to 48 business hours (Monday to Friday): 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 or Urine for testing. The lab tech will contact you to schedule this house-visit. Urine samples can be self-collected using the provided collection instructions, without the need for a nurse or phlebotomist.

Step 3
Your Blood or Urine sample will be shipped to our Next-Generation Sequencing Lab. Our team will perform the first part of the process –including exosome isolation and RNA purification and conversion to cDNA – to prepare for NGS sequencing.

Step 4
Our lab team will use our state-of-the-art genetic sequencing technology to identify if molecular signatures 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 5
Within three weeks of our lab receiving your sample, your results will be presented to you in a detailed and easy-to-understand report.

*If your results indicate cancer activity, and/or you would like to discuss the results with our Precision Oncology Molecular Reasearch and Patient advocacy team(s), these support services are available for an additional fee.

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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What is the reason you want the LRNA Liquid Biopsy?* This field is required.Please select the option that applies to you most.
I wonder if I have any ongoing cancer activity.
I have been diagnosed with cancer and want to confirm any current cancer activity.
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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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 LRNA Liquid Biopsy for you?* This field is required.
YESNO
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If the LRNA Liquid Biopsy is not for you, please write the patient's name:
First Name
Last Name
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What is your relationship to the patient:
Parent
Child
Spouse or significant other
Family member
Advocate
Friend
Caregiver
Prefer not to say
Other
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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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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
Prefer not to say
Other
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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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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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Weight and Height?
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Relevant Family History* This field is required.N/A if none:
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Current Symptoms* This field is required.N/A if none:
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What type of cancer have you been diagnosed with?* This field is required.N/A if none:
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Are you currently on treatment?* This field is required.
Yes
No
Unsure
Previous Treatment
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What treatment are you currently on (name) and what cycle are you on? OR Previously on?N/A if none:
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Please tell us your preferred method of follow-up communication:
Phone call
Email
Text message (SMS)
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How did you hear about us?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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Reason For Ordering* This field is required.Select all that apply:
Early Detection
Personal History of Cancer
Family History of Cancer
Hereditary Cancer Risk
Unexplained Symptoms
Abnormal Imaging
Abnormal Bloodwork
High Risk
Monitoring after Diagnosis
Other
General Molecular Profiling
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Cancer Risk Information* This field is required.Select all that apply:
No known cancer history
Previous Cancer Diagnosis
Current Cancer Diagnosis
Under Investigation
Other
Prefer not to say
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Please give us permission to email you about your LRNA 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 is for the purpose of providing LRNA Liquid Biopsy testing coordination and related cancer care support.
I agree and give my informed consent.
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We Value Your Privacy

At Liquid Biopsy Labs, 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 Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA). 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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Consent and Acknowledgment:* This field is required.Check all fields to confirm:
I understand the L-RNA is a molecular profiling assay.
I understand that the assay is intended to provide supplemental molecular information.
I understand that this assay does not replace physician evaluation, imaging, pathology, or other standard investigations.
I confirm that the information provided is accurate to the best of my knowledge
I agree to be contacted regarding sample collection, payment and reporting logistics.
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Signature
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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 LRNA 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 or email us directly at clientcare@liquidbiopsylabs.com

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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