ASPER ONCOGENETICS SAMPLE SUBMISSION FORM
                                              ORDERING PERSON AND REPORTING                                            ADDITIONAL REPORTING INFORMATION 
                                              INFORMATION                                                              (if applicable)
               Name 
               (first name, 
               last name)
               Institution
               Address
               E-mail
               Phone
               Results delivery                    by e-mail                                 by regular mail
               Sample receipt                 Person
               confirmation                   E-mail 
               BILLING INFORMATION
               By submitting DNA samples to Asper Biogene the client agrees that invoices shall be paid within 10 calendar days as of the invoice date and in 
               case of delay in the payment, the open invoice amounts will accrue interest amounting to 0,1 % per calendar day. 
               Contact person
               Institution
               Address
               E-mail
               Phone
               VAT account 
               number
               In EU countries please add paying institution's VAT account number, otherwise 20% of VAT tax will be added to the invoice.
               PO number
               Invoice delivery                    by e-mail                                 by regular mail      
               Patient’s data 
               needed for                          yes                                       no
               invoicing
               SAMPLE INFORMATION
               Type                                whole blood in EDTA                       DNA                                       Other......................................
               Date of collection 
                                              Fetal sample (for prenatal testing)                                      Maternal sample (for prenatal testing)
               Date of collection 
               Type                                DNA from CVS                             DNA from                        DNA                                whole blood in 
                                                                                              amniocentesis            EDTA
               Method and/or kit 
               of DNA extraction
               PATIENT INFORMATION
               Name 
               Date of birth
               Sex
               Ethnic origin
               Clinical diagnosis
             Asper Biogene LLC • Vaksali 17A, 50410 Tartu, Estonia • phone +372 7307 295 • info@asperbio.com • www.asperbio.com                                                              1
             version 08/09/2021
            ASPER ONCOGENETICS TESTS
                                                                                     NGS panel of genes with CNV
                                                                                     Sequencing of BRCA1, BRCA2 genes
            Breast and Ovarian Cancer                                                Del/dup analysis of BRCA1, BRCA2, CHEK2 genes by 
                                                                                 MLPA
                                                                                     Sequencing + del/dup analysis of BRCA1, BRCA2 genes 
                                                                                 by MLPA
            Cancer Predisposition                                                    NGS panel of genes with CNV
                                                                                     Sequencing of APC gene
            Familial Adenomatous Polyposis
                                                                                     Del/dup analysis of APC gene by MLPA
                                                                                     NGS panel of genes with CNV
            Fanconi Anemia                                                           Del/dup analysis of FANCA, FANCB, FANCD2, PALB2 
                                                                                 genes by MLPA
                                                                                     NGS panel of genes with CNV
                                                                                     Microsatellite instability
                                                                                     Sequencing of MLH1 gene
            Lynch Syndrome                                                           Sequencing of MSH2 gene
                                                                                     Sequencing of MSH6 gene
                                                                                     Del/dup analysis of MLH1, MSH2 genes by MLPA
                                                                                     Del/dup analysis of MSH6 gene by MLPA
                                                                                     NGS panel of genes with CNV
            Melanoma                                                                 Del/dup analysis of CDK4, CDKN2A, CDKN2B, MITF 
                                                                                 genes by MLPA
                                                                                     Sequencing of MUTYH gene
            MUTYH-Associated Polyposis                                               Targeted mutation analysis
                                                                                     Del/dup analysis of GREM1, MUTYH, SCG5 genes by 
                                                                                 MLPA
                                                                                     Sequencing of NBN gene
            Nijmegen Breakage Syndrome
                                                                                     Targeted mutation analysis
                                                                                     NGS panel of genes with CNV
            Polyposis Syndromes                                                      Del/dup analysis of BMPR1A, PTEN, SMAD4, STK11 
                                                                                 genes by MLPA
            Prostate Cancer                                                          NGS panel of genes with CNV
            Renal Cancer                                                             NGS panel of genes with CNV
          Asper Biogene LLC • Vaksali 17A, 50410 Tartu, Estonia • phone +372 7307 295 • info@asperbio.com • www.asperbio.com                        2
          version 08/09/2021
          ASPER ONCOGENETICS TESTS
                                                                             NGS panel of genes with CNV
          Thyroid Cancer                                                     Del/dup analysis of MEN1, SDHB, SDHC, SDHD genes by 
                                                                         MLPA
          Von Hippel-Lindau Disease                                          Sequencing of VHL gene
          CUSTOM TEST
              NGS panel of genes with CNV
              Del/dup analysis by MLPA
              Del/dup analysis of selected regions by 
          Chromosomal Microarray Analysis
              Single gene sequencing
              Single mutation analysis
         PATIENT’S CLINICAL INFORMATION
         Reason for referral
             confirmation of clinical diagnosis                 testing of at-risk family members
             cancer predisposition assessment                   risk assessment for adverse drug reactions
         Age at the onset of symptoms………….............................
         Patient´s clinical features 
             no symptoms 
                                                                                                                              cancer,
         location..............................................................................................................................................................
         Previous genetic testing 
             not done
             results: 
              .......................................................................................................................................................................................
              .......................................................................................................................................................................................
         Family history
             unknown
             
         diagnosis…………………………………………………………………………………………………………........................
              specify the relation to the proband and age at diagnosis………………………………………………………………….....
              .......................................................................................................................................................................................
         Authorization to use remaining sample material and test results
         Asper Biogene may use de-identified (without personal identifying information) remaining sample material and test re-
         sults for quality improvements and/or scientific purposes. 
             I give my consent to use my de-identified sample material and test results as described above
             I do not give my consent to use my de-identified sample material and test results as described above
         Name of patient………………………………………………………………………………………………………………………
         Patient’s signature……………………………………………………………………………………………………………………
         Date……………………………………………………………………………………………………………………………………
         Asper Biogene LLC • Vaksali 17A, 50410 Tartu, Estonia • phone +372 7307 295 • info@asperbio.com • www.asperbio.com          3
         version 08/09/2021
          Important: By sending samples and placing an order customer accepts Terms and Conditions and Privacy Policy of 
          Asper Biogene (see website for details).
          Asper Biogene LLC • Vaksali 17A, 50410 Tartu, Estonia • phone +372 7307 295 • info@asperbio.com • www.asperbio.com                        4
          version 08/09/2021