KRAS-variant Order Form "*" indicates required fields Step 1 of 9 – Your Reason(s) for Testing 0% WelcomePlease select your reason(s) for testing. Check all that apply:* Personal history of cancer Family history of cancer Making decisions regarding estrogen therapy ConsentI understand that by ordering and receiving my KRAS-variant results, I am agreeing to join a research registry. Click here to review the consent document. The registry consists of periodic questionnaires. The purpose of this registry is to continue to find solutions for individuals with the KRAS-variant and genetic biomarkers like it, to improve their health and outcomes. I have read the protocol and agree to participate in the registry. Please note that all information supplied is secure and protected and will never be shared except per your agreement or request.If you agree to these terms, type your full name below.* I understand that the KRAS-variant test is considered a genetic test. Please read the consent for genetic testing here. * I agree to genetic testing ResultsPlease note that results must be shared with a physician of your choice. Have your physician’s phone, email address and fax number ready. * I agree to have my results shared with a physician of my choice I also request to have the results shared directly with me when shared with my physician Patient InformationName* First Last Email* Enter Email Confirm Email Phone Number* Your Birth Date*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920In your personal history of cancer, please indicate:Type of Cancer* Stage of Cancer* In your family history of cancer, please indicate:Type of Cancer* Stage of Cancer* Patient Shipping AddressYour Shipping Address*We currently ship to the United States. If you need a test kit shipped to another country, please do not complete this form and contact us at KRAS@miradx.com. 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I would like to receive the MiraKind newsletter to keep up to date on their findings.* Yes, please subscribe me No thanks How did you hear about MiraKind?* Friend or family member Online search Other Test Price: Click if you have a codeCode MiraKind needs your support! MiraKind is a research nonprofit organization committed to advancing understanding of our genetics and allowing access to meaningful genetic information. By supporting MiraKind, you are helping others access their genetic results and furthering our research to personalize healthcare. Any amount helps!Enter a Tax-Deductible Donation Amount Total Credit Card*Card Details Cardholder Name Almost done! Please click “Send” only ONE TIME to complete your order. Give the system a minute or so to process your order and then you will be redirected to a success page. Thank you!