HLA Loss of Heterozygosity Buccal Kit Request Form

Thank you for your interest in Versiti’s HLA Loss of Heterozygosity (LOH) testing. To request buccal kits for clinical testing of LOH, please complete the form below. 

You will need your Versiti client ID number to complete the request.

To receive your client number, or for NEW clients who have not used Versiti testing in the past, please contact Versiti client services at 800-245-3117 x 6250 or Labinfo@versiti.org to set up your account before placing your kit request.

Please note, Versiti’s LOH test is performed in collaboration with Hematologics, Inc (Seattle, WA) and requires the collection of two sample types. A buccal sample, collected using a Versiti LOH buccal kit, should be sent to Versiti Wisconsin, while an active relapse sample (blood or bone marrow) should be separately collected and sent to Hematologics.

• LOH Ordering Instructions
• LOH Requisition Form