ClariGenoMic Research & Solutions
Microbiology Service Requisition Form
Microbiology
Microbiology Sample
Submission Request

Fill this form before dispatching your samples to ClariGenoMic. Our team will confirm and guide you on packaging and dispatch.

01

Your name?

Name of the researcher, clinician, or contact person submitting this request.

Please enter your name
02

Institute & contact

We will use this to send your results and updates.

Required
Valid email required
Phone required
03

Microbiology Service Type

Select the service you require.

Other / Specify your requirement:

Please select a service
04

Sample Source / Type

Select one or multiple that apply.

Other (specify):

Please select at least one
05

Sample Details

Add each sample you are sending, with a short description and quantity. Add suspected organism if known (optional).

Please add at least one sample
06

Testing Requirements

Select what analysis you need. Multiple allowed.

Advanced / Custom Requirements

Describe any specific organisms to screen for, comparison groups, or reporting standards needed.

Preferred Output Format

07

Special Instructions

Any additional notes, comparisons, groupings, or special requests for our team.

08

Review & Submit

Please confirm your details before submitting.

By submitting you confirm all samples are safe to handle and non-hazardous.

Request Submitted!

Thank you! Our team will review your microbiology testing request and contact you within 24 hours with sample dispatch instructions.

📞 8624 89 2921
✉ info@clarigenomic.co.in