1Provider Service Agreement
2Portal Access
  • I accept responsibility for the ordering of COVID-19 tests from my office/clinic that are sent to Southwest Regional PCR/MicroGenDX Laboratory. I will still provide a requisition with each sample, which should be deemed as my written request to perform specified test. Your PSA information will be saved in the MicroGenDX system for any of your possible future requests of all offered MicroGenDX specialties. I will inform Southwest Regional PCR/MicroGenDX Laboratory, at 1-855-208-0019, if I would like to end this electronic authorization agreement.
  • Physician Information

  • I understand the authorization code requested that allows my patient access to order a COVID-19 at-home collection from MicroGenDX does not fall under MicroGenDX's FDA EUA authorization. I acknowledge that this MicroGenDX COVID-19 test for at home collection is not authorized under the FDA EUA. I acknowledge and understand that the COVID19 test will instead be run by MicroGenDX as a validated test under their high complexity CLIA/CAP license.
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  • Upon completing and submitting the PSA form you will receive a confirmation email. Once your PSA information has been verified, you will be emailed an authorization code and a direct link to the MicroGenDX COVID-19 test kit ordering page.