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Please enter the information for the patient who will be completing the test.

First name

Last name

Email

Password

Confirm Password

Sex at Birth

Male Female Unknown

Country

Region

City

Postal Code

Address line 1

Address line 2

Plan Member Id

Promo Code

Date of Birth

I provide my consent for GSC to share my demographic data with GenXys Health Care Systems for the purpose of creating an account. Learn more

Yes No

I provide my consent for GSC to share my drug claims-related data with GenXys Health Care Systems in order to personalize my medication treatment options in TreatGx. Learn more

Yes No

"ShowConsent"

Yes No

"ShowPendingKitDelivery"

Yes No

"ShowPromoCode"

Yes No

"ShowDemographics"

Yes No

"ShowDOB"

Yes No

"ShowPassword"

Yes No

"ShowAddress"

Yes No

"ShowCompleted"

Yes No

"ShowConfirm"

Yes No

"ShowPayment"

Yes No

"ShowNextButtonGeneral"

Yes No

"ShowNextButtonPayment"

Yes No

"VerifyAction"

"CustomerMode"

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