Patient Information Form

Thank You for submitting patient information. Sample Requirements: DNA or EDTA whole blood Additional citrated plasma sample is required where possible Ship to the following address: Molecular Hemostasis Laboratory Department of Pathology and Molecular Medicine, Richardson Laboratory, Room 201 Queen’s University, Kingston, Ontario K7L 3N6 Tel: 613-533-3187 FAX: 613-533-2907 Email: nphmt@clinlabs.path.queensu.ca If you have further inquiries please don't hesitate to contact me at othman@queensu.ca Regards, Dr. Maha Othman MD MSc PhD Adjunct Assistant Professor Department of Pathology and Molecular Medicine Queen's University Kingston, Ontario Canada K7L 3N6 Phone Lab: 613 5332822 Office: 613 533 6000 ext 79027 Fax: 613 5332907