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.

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 login 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.

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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