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Hi this is ______ from Quantum Wellness, we received your request for a Cardio Genetic Screening is _____ available?


Ok great I’m going to ask you some personal & health related questions that will serve as a medical intake. That will determine which test is best suited for you.


Have you ever taken an in home swab test for Cardio related issues?

If so, when?


First Name :

Last Name :

Primary Phone Number :

Best Time To Contact :

And what is your email address so we can send you instructions and tracking information for your kit?

Date of Birth :

Address :

City :


Zip g

Ethnicity :

Gender :




Medicare/Insurance ID Number (NO DASHES/SPACES) *

Group # (If Private)

BIN # (If Private)

Doctor Name

Doctor Phone Number

Doctor NPI


Have you ever been diagnosed with?

High cholesterol

High Blood Pressure


Coronary Heart Disease

Vascular Disease

Tendon Xanthoma

Corneal Arcus

Have you ever had any of the following?

Heart attack

Heart Failure


TIA's (mini strokes)

Have you ever had surgery on your heart for preventatives?

Stents, pacemakers?

Now what about your family members?

*Must ask same questions for family members, try to find immediately family member(Mother, father, brother, sister, son, daughter, uncle, aunt)


Need 1 family member with cardio history*

Now, have you EVER taken any medications for your heart? Any blood pressure meds or blood thinners?

How about any anti-depressants or anti-anxiety medicines?


Current Blood Pressure/Heart Medications, or Anti-Depressant/Anxiety Medications :

Past Blood Pressure /Heart Medications, or Anti-Depressant/Anxiety Medications:

OTC Medications:

It looks like you qualify for this brand new cardio genetic test that is a benefit through your Medicare insurance.


Ok great, so it looks like the lab that will be handling your testing sample will be Bio Choice.



We will be contacting your primary care physician within the next 24 to 48 hours to confirm your eligibility for the test. Your doctor may contact you to verify that you requested this testing. If needed, we may ask to do a conference call with you and your doctor.



Once we get the approval from your doctor the lab is going to mail your kit through express mail, which usually takes 2-3 business days.



The test will arrive in a white or red box labeled "Capital Advantage Diagnostics." Inside are instructions and a phone number so you can call and have a HIPPA Certified specialist walk you through the process.



The lab has full tracking on the package, so they can see when it has been delivered. If we do not hear from you within 1 or 2 days, you will be contacted by a HIPPA Certified specialist.



The Specialist will walk you through how to properly swab your cheeks, sign off on the requisition form, and re-package the sample with their pre-paid postage. The whole process is very simple and takes about 3 minutes from start to finish. Now the hardest part is left on you, that is putting it in the mailbox.



It's very important that you pick up when the specialist tries calling you. If they miss you, they will leave a voicemail. This is a new technology that Medicare is willing to pay for in order to save lives. It is ultimately up to you to communicate with the lab and get your sample sent back out as soon as possible. Your results will be mailed directly to you within 6 to 8 weeks from the time the lab receives your sample.



Now, do you have any questions for me?

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