Please read the legal disclaimer below before completing and submitting this form. The form should be filled out in its entirety.
It is important to let relatives and offspring who are interested know that this is available and a rare opportunity.
Thank you, William Lowery MD
DISCLAIMER: As a California licensed physician and an ordering physician I can order a variety of genetic tests for individuals seeking genetic screening or confirmation. Although not a trained geneticist I have a functional knowledge of what genetic tests need to be done in the realm of muscular dystrophy. Genetic test ordering by paper or online can be unfamiliar and a tedious undertaking to most primary care providers and general neurologists.
As a result I would be willing to act as an ordering physician facilitator for individuals needing and qualifying for free testing . I would not be entering into a physician patient relationship with you but mainly a test ordering conduit. Discussing test results and verifying test results would be done with your primary care provider, primary neurologist.
If you consent to this process you would complete and submit this form which asks for important data for the test kit. Your data is protected by Google Suite and I follow HIPAA guidelines for personal medical data. Once the order is submitted and approved then a sputum kit with instructions is mailed to you. You will submit your specimen and the results may take 2-4 weeks to reach you.