Insurance Preverification

Filling out the Insurance Preverification Form will help Ambry estimate the out-of-pocket cost for your patient’s genetic testing. This form is intended for use by doctors, nurses, genetic counselors, and other medical professionals.

NOTE: This service is only available for the ExomeNext® and Microarray tests. It is not available for hereditary cancer risk, cardiology, or neurology tests.

Please download, fill out the appropriate fields, and save to your desktop. Choose from one of the following steps to submit your form:

  1. Secure email to
  2. Secure upload through and select Destination: Preverification
  3. Print and fax to +1 949-900-5501

You can also log in to AmbryPort® and complete the form within your account.

Once the form is submitted, our Preverification team will send you an estimate in approximately 72 hours.

Download Preverification of Benefits Form

This form is not a TRF. To submit a sample for genetic testing, a completed TRF needs to be sent with the sample kit. For your convenience, our online TRFs can be found here.

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