Refer A Patient

Thank you for your confidence in GenepoweRx Genetic Test. We request you to fill out the form below to refer your patients. We take less than 24 hours to reach you.

If it is urgent

you may email us @

refer@genepowerx.com

or Call us @

9848999779

Referring Physician Information

First Name

Last Name

Office Phone

Mobile Phone

What is Your relationship with the Patient?

Patient’s Contact Information

First Name

Last Name

Date of Birth

Mobile Phone

Caregiver’s Contact Information

First Name

Last Name

Mobile Phone

Patient’s Medical History:

Cracking the ‘One Size Fits All’ theory of medical science while inculcating the philosophy of “You are unique, and so should your medical treatment be”,