Kit Order Form
Clinical Testing kits are provided as a courtesy.
There is no charge when ordering kits.
Kits will include pre-paid return postage.
Kit requests may take up to 1 week for delivery.
Kits are being sent to
Before submitting a specimen collection kit order, confirm your patient meets the eligibility criteria. If they do not meet eligibility, please contact us at
email@example.com or 715-387-0484 option 2 to request an exception. The ordering healthcare provider must complete and sign a
Behind The Blur Test Requisition Form and email it to firstname.lastname@example.org or fax it to 715-406-4175 prior to receipt of the patient's specimen at the lab. A copy of the patient consent form will be included in the specimen collection kit sent to your patient's home.
Patients must meet the criteria below:
Patient age of 18 months to 35 years.
Patient has current or history of idiopathic bilateral cataract(s) (e.g., not known to be due to infectious causes, trauma, etc.)
Patient lives in the U.S.
Please select the number of blood kits you wish to order:
0 1 2
Please select the number of saliva kits you wish to order:
0 1 2
Please select the number of buccal kits you wish to order:
0 1 2
If your patient has had a bone marrow transplant or recent blood transfusion, the above kit types may not be recommended. Please
contact us for further details, referencing SP132.
Blood specimens are always preferred. However, saliva and buccal collections kits are also available. When deciding specifically between a saliva or buccal collection kit for your patient, please consider their age and ability. For younger patients, a buccal collection may be more suitable.
Number of Mailing Labels