Order Your KRAS-Variant Test Step 1 of 9 11% Name* First Last Email* Your Email Please Confirm Your Email Would you like:*To know my KRAS-variant Results, $159To know my KRAS-variant Results and to submit my DNA for research studies, $149Why submit my DNA for research? By joining a MiraKind study, you can play a role in helping MiraKind answer some of the most pressing questions associated with risk of disease in individuals. We are on a mission to better understand the behaviors, environmental factors, and lifestyle choices that can influence an individual’s risk of cancer, and your participation in a study helps us get closer to finding the answers to improve health for all individuals with the KRAS-variant, as well as to understand new mutations like the KRAS-variant. Good to know: To participate in our research studies, you'll need to complete a survey that takes about 15 minutes.Have you already taken a survey to participate in a study and need a kit to send your sample in?*YesNoThis is a fairly long form that asks about you and your family medical history. Most likely you'll remember if you've done it. Before you order, please note that a physician must deliver your test results. You have the option of using your own or you may select one of our partners that can connect you with a physician. If you choose to use your own, be sure to have your physician's phone number and address ready. Our partner, Gennev, has OB/GYNs that charge $55 for 20 minutes or $85 for 30 minutes to discuss your results and to answer any questions you may have. IMPORTANT: After submitting your information, you will need to complete a 15 minute survey so we have the information and permission we need for using your sample in our studies. Completion of the survey is required. Reason(s) for testing, check all that apply:* Personal history of cancer Family history of cancer Personal or family history of more than one cancer in an individual (multiple primary cancer) To help guide the decision regarding hormone replacement therapy Current cancer diagnosis for information to help guide the decision on treatment choice Other Please list your other reason(s) for testing: Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Birth Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Physician (Note: A physician must be involved in the reporting of this test. If you need one a physician, please select one of our partners)*I need to request a physician through your partner, Gennev, and I understand there is a $55 fee to receive and discuss my results with an OB/GYNI have a physicianYour Physician's Name* First Last Your Physician's Phone Number*Your Physician's Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country I understand the benefits and limitations of the testing to be performed as indicated. I understand that a positive test result serves only as a predictor of risk or response. I understand that a negative test results does not assure no risk or response. I understand a physician must deliver my results to me. I consent to being tested for the KRAS-variant. I agree that I have read and accept the above terms* I agree I acknowledge I am responsible for $159 when I submit this form. I understand my individual results and information will never be shared without my permission. I do give MiraKind consent to release my results to my chosen physician.* I agree I acknowledge I am responsible for $149 when I submit this form. I understand my individual results and information will never be shared without my permission. I do give MiraKind consent to release my results to my chosen physician.* I agree MiraKind is an independent non-profit that runs studies to answer questions about cancer for individuals and their families with novel germline mutations. I would like to be signed up for the MiraKind newsletter to keep up to date on studies and results from studies.* Yes, please subscribe me No thanks KRAS-variant Test Price: $159.00 KRAS-variant Test with Study Submission Price: $149.00 Total $0.00 Credit Card Card Details Cardholder Name ShareTweetShare0 Shares
