PGX KIT REQUEST FORM 

Request kits for your practice with the submission of this form. We provide every kit free of charge and we cover all shipping. Kits can be stored at room temperature. Each kit comes with a Requisition Form, instructions, swabs, tub and holder.  A GnomeDX representative will contact you with the submission of this form to verify your request. For more information about the test process visit our get started page

Clinician Name *
Clinician Name
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GNOMEdx 

614- 431- 6414

1476 Manning Parkway

Powell, Ohio 43065