Inquiry Survey

Question Title

* 1. Contact Information

Name *

Company

Email Address *

Question Title

* 2. If your inquiry is regarding a specific gene please indicate here.

CACNA1S

CFTR

CYP2B6

CYP2C9

CYP2C19

CYP2D6

CYP3A5

CYP4F2

DPYD

G6PD

HLA

IFNL3

mt-RNR1

NUDT15

SLCO1B1

TPMT

VKORC1

UGT1A1

Other (please specify)

Question Title

* 3. If your inquiry is regarding specific allele(s) or variant(s) or phenotype(s) please include here.

Question Title

* 4. Please indicate which of the following options best describes the nature of your inquiry.

Clinical study with potentially conflicting evidence which may change phenotype resulting in altered prescribing recommendations

New potentially conflicting evidence which contradicts the role of the allele in the specified drug phenotype

New evidence to support current assertions

New evidence to support assigning a clinical function to an unknown or uncertain function allele

Data entry error

Other (please specify)

Question Title

* 5. Please attach supporting evidence documents, if applicable.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Inquiry

Question Title

* 1. Contact Information

Question Title

* 2. If your inquiry is regarding a specific gene please indicate here.

Question Title

* 3. If your inquiry is regarding specific allele(s) or variant(s) or phenotype(s) please include here.

Question Title

* 4. Please indicate which of the following options best describes the nature of your inquiry.

Question Title

* 5. Please attach supporting evidence documents, if applicable.

Question Title

* 6. Please provide details and any additional information to help us address your inquiry.