In order for Moleculera Labs to send Cunningham Panel results to parents or providers other than the ordering prescriber, a signed Release of Information form must be on file. This gives Moleculera Labs permission to send the completed report via unencrypted email to the person specified on the Release of Information form.

The information for the recipient must be complete, including the physical address, email address and/or fax number for the recipient and the signature of the person making the request.

Click on the link to access and download the Release of information Form.

Please return form to:
Moleculera Labs, Inc.
755 Research Parkway, Suite 410
Oklahoma City, OK 73104
Fax: (405) 239-5255

Email: button(2)