{"id":260,"date":"2020-03-30T23:08:03","date_gmt":"2020-03-31T06:08:03","guid":{"rendered":"http:\/\/lgmd1d.org\/lgmdwp\/?page_id=260"},"modified":"2025-11-20T21:03:31","modified_gmt":"2025-11-21T05:03:31","slug":"no-cost-genetic-testing","status":"publish","type":"page","link":"https:\/\/lgmd1d.org\/lgmdwp\/no-cost-genetic-testing\/","title":{"rendered":"No Cost Genetic Testing for Muscular Dystrophy Form:"},"content":{"rendered":"\r\n<p><strong>Please read the legal disclaimer below before completing and submitting this form.<\/strong> <strong>The form should be filled out in its entirety. <\/strong><\/p>\r\n\r\n\r\n\r\n<p><strong>It is important to let relatives and offspring who are interested know that this is available and a rare opportunity.<\/strong><\/p>\r\n\r\n\r\n\r\n\r\n\r\n<p><strong>Thank you, William Lowery MD<\/strong><\/p>\r\n\r\n\r\n\r\n<p><span class=\"has-inline-color has-vivid-red-color\"><strong>DISCLAIMER<\/strong>: <strong>As a California licensed physician and an ordering physician I can order a variety of genetic tests for individuals seeking genetic screening or confirmation.\u00a0 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.<\/strong><\/span><\/p>\r\n\r\n\r\n\r\n<p><strong><span class=\"has-inline-color has-vivid-red-color\">As a result I would be willing to act as an ordering physician facilitator for individuals needing and qualifying for free testing .\u00a0 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.<\/span><\/strong><\/p>\r\n\r\n\r\n\r\n<p><strong><span class=\"has-inline-color has-vivid-red-color\">If you consent to this process you would complete and submit this form which asks for important data for the\u00a0 test kit.\u00a0 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.\u00a0 You will submit your specimen and the results may take 2-4 weeks to reach you.<\/span><\/strong><\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong><span class=\"has-inline-color has-vivid-green-cyan-color\">The Application: wslowery.57@lgmd1d.org<\/span><\/strong><\/h2>\r\n<h2>\u00a0<\/h2>\r\n\r\n\r\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-247\"><form id=\"wpforms-form-247\" class=\"wpforms-validate wpforms-form\" data-formid=\"247\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/lgmdwp\/wp-json\/wp\/v2\/pages\/260?wpforms_form_id=247\" data-token=\"c774fd6fe8693eb6c5adb248a5d83b31\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-247-field_22-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_22\"> Neuromuscular Panel (may reflex to other panels later)<\/label><ul id=\"wpforms-247-field_22\"><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_22_2\" name=\"wpforms[fields][22][]\" value=\"Comprehensive Muscular Dystrophy Panel\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_22_2\">Comprehensive Muscular Dystrophy Panel<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_2\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-247-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" required><label for=\"wpforms-247-field_2\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-247-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" required><label for=\"wpforms-247-field_2-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-247-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_18\">Date of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-247-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required><\/div><div id=\"wpforms-247-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_3\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-247-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-247-field_4-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_4\">Cell Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-247-field_4\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-247-field_5-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_5\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-247-field_5\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][5][address1]\" required><label for=\"wpforms-247-field_5\" class=\"wpforms-field-sublabel after \">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-247-field_5-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][5][address2]\" ><label for=\"wpforms-247-field_5-address2\" class=\"wpforms-field-sublabel after \">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-247-field_5-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][5][city]\" required><label for=\"wpforms-247-field_5-city\" class=\"wpforms-field-sublabel after \">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-247-field_5-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][5][state]\" required><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-247-field_5-state\" class=\"wpforms-field-sublabel after \">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-247-field_5-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"99999[-9999]\" data-inputmask-greedy=\"false\" data-rule-empty-blanks=\"1\" name=\"wpforms[fields][5][postal]\" required><label for=\"wpforms-247-field_5-postal\" class=\"wpforms-field-sublabel after \">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-247-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_6\">Sex <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-247-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-247-field_6_1\" name=\"wpforms[fields][6]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_6_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-247-field_6_2\" name=\"wpforms[fields][6]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_6_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_7-container\" class=\"wpforms-field wpforms-field-payment-multiple\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_7\">Ancestry <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-247-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-247-field_7_1\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"1\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_1\">Askenazi Jewish<\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-247-field_7_2\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"2\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_2\">Black\/African America<\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-247-field_7_3\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"3\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_3\">Hispanic<\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-247-field_7_4\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"4\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_4\">Native American<\/label><\/li><li class=\"choice-5\"><input type=\"radio\" id=\"wpforms-247-field_7_5\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"5\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_5\">Sephardic Jewish<\/label><\/li><li class=\"choice-6\"><input type=\"radio\" id=\"wpforms-247-field_7_6\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"6\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_6\">Asian<\/label><\/li><li class=\"choice-7\"><input type=\"radio\" id=\"wpforms-247-field_7_7\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"7\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_7\">French Canadian<\/label><\/li><li class=\"choice-8\"><input type=\"radio\" id=\"wpforms-247-field_7_8\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"8\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_8\">Mediterranean<\/label><\/li><li class=\"choice-9\"><input type=\"radio\" id=\"wpforms-247-field_7_9\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"9\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_9\">Pacific Islander<\/label><\/li><li class=\"choice-10\"><input type=\"radio\" id=\"wpforms-247-field_7_10\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"10\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_10\">White\/Caucasian<\/label><\/li><li class=\"choice-11\"><input type=\"radio\" id=\"wpforms-247-field_7_11\" class=\"wpforms-payment-price\" data-amount=\"0.00\" name=\"wpforms[fields][7]\" value=\"11\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_7_11\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_10\">Do You have Symptoms? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-247-field_10\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_10_1\" name=\"wpforms[fields][10][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_10_2\" name=\"wpforms[fields][10][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_10_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_12-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_12\">Do you have this condition in your family? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-247-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_12_1\" name=\"wpforms[fields][12][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_12_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_12_2\" name=\"wpforms[fields][12][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_12_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_13-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_13\">Have you had genetic testing before? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-247-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_13_1\" name=\"wpforms[fields][13][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_13_2\" name=\"wpforms[fields][13][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_13_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_15\">Describe your first symptom and age of onset.  Eg &quot;weakness, 45&quot; <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-247-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" required><\/div><div id=\"wpforms-247-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_16\">Any family history of this condition and age of diagnosis, otherwise put &quot;NA&quot;? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-247-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" required><\/div><div id=\"wpforms-247-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_17\">Is genetic testing positive in you or family? IF YES then UPLOAD below or take a picture of the front page result and attach to email: WSLOWERY.57@LGMD1D.ORG  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-247-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_17_1\" name=\"wpforms[fields][17][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_17_2\" name=\"wpforms[fields][17][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_17_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-247-field_17_3\" name=\"wpforms[fields][17][]\" value=\"Don&#039;t Know\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-247-field_17_3\">Don't Know<\/label><\/li><\/ul><\/div><div id=\"wpforms-247-field_19-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_19\">If you can please upload the genetic test result (PDF,JPG\/JPEG,PNG)<\/label><div class=\"wpforms-uploader\"\n\tdata-field-id=\"19\"\n\tdata-form-id=\"247\"\n\tdata-input-name=\"wpforms_247_19\"\n\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\tdata-max-size=\"536870912\"\n\tdata-max-file-number=\"1\"\n\tdata-post-max-size=\"536870912\"\n    data-max-parallel-uploads=\"4\"\n    data-parallel-uploads=\"true\"\n\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" class=\"\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"#B1B1B1\" aria-hidden=\"true\"><path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path><\/svg>\n\t\t<span class=\"modern-title\">\n\t\t\tClick or drag a file to this area to upload.\t\t<\/span>\n\n\t\t\t<\/div>\n<\/div>\n<input type=\"text\" class=\"dropzone-input\"\n\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\tid=\"wpforms-247-field_19\"\n\tname=\"wpforms_247_19\" >\n<\/div><div id=\"wpforms-247-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_25\">Your regular doctor&#039;s name?  (Put NA if unable) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-247-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required><\/div><div id=\"wpforms-247-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-247-field_26\">Your regular doctor&#039;s phone number? (Put your number if unable) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-247-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-247-field-hp\" class=\"wpforms-field-label\">Comment<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-247-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha\" ><div class=\"g-recaptcha\" data-sitekey=\"6LdHacsUAAAAAB9u2Q1qK3rNuk28Er4Vrd5g0U8o\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" required><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"247\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-247\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"<p>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.\u00a0 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 .\u00a0 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\u00a0 test kit.\u00a0 Your data is&#8230;<\/p>\n<div class=\"more-link-wrapper\"><a class=\"more-link\" href=\"https:\/\/lgmd1d.org\/lgmdwp\/no-cost-genetic-testing\/\">Continue reading<span class=\"screen-reader-text\">No Cost Genetic Testing for Muscular Dystrophy Form:<\/span><\/a><\/div>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-260","page","type-page","status-publish","hentry","entry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>No Cost Genetic Testing for Muscular Dystrophy Form: - LGMD1D Foundation and Autosomal Dominant LGMD Registry<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lgmd1d.org\/lgmdwp\/no-cost-genetic-testing\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"No Cost Genetic Testing for Muscular Dystrophy Form: - LGMD1D Foundation and Autosomal Dominant LGMD Registry\" \/>\n<meta property=\"og:description\" content=\"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.\u00a0 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 .\u00a0 I would not be entering into a physician patient relationship with you but mainly a test ordering conduit. 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