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Be Website http //www. molgen.ua.ac.be/DNAdiagnostics DSF director Christine Van Broeckhoven PhD DSc DSF REQUEST FORM GENETIC TESTING Please mention name first name and date of birth on the sample tubes. Diagnostic Service Facility DSF Laboratory of Neurogenetics Institute Born-Bunge University of Antwerp CDE Building V Parking P4 Universiteitsplein 1 B-2610 Antwerp Tel. 32 3 265 1020 Fax 32 3 265 1037 E-mail DSF bornbunge. Please check the box if the patient does NOT agree Copy of results to...
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