Huron Valley Genetic Consulting   Make An Appointment  

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Once you have scheduled your
genetic counseling appointment
please click on the link below for
our family history questionnaire.
Please complete this and fax it to
HVGC before your appointment.
Our fax number is 248-778-4065.

Click here of our Family History
Intake Form

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If you are interested in receiving genetic counseling from HVGC, please fill out the following form. One of our certified genetic counselors will be in contact with you within 24 hours to schedule an appointment. There is no commitment associated with this form and all of the information will be sent directly to HVGC. Complete privacy is assured. Thank you.

Appointment Request
Name:



Street Address:



City:



State:



Zip Code:



Country:



E-Mail:



Home Phone:



Cell Phone:



Preferred
Contact
Method:

E-MailPhoneNo Preference
Appointments are available Monday - Friday and occasionaly on Saturday and Sunday. Please list three dates and times that work best for you. Please keep in mind, it is best if you and your partner are available for the consultation.



Please briefly explain the reason you would like to speak to a genetic counselor:



Optional: How did you hear about HVGC?



If you were referred to HVGC, please list the name of your referrer:



 




































































































Contact Information:
Phone: 248-942-3972
Fax: 248-778-4065
E-mail: info@hvgc.net
URL: www.hvgc.net