Download Your Physician Test Requisition Form

Select the requisition form for your province or territory below. The form must be completed and signed by a physician before testing can proceed.

Patients can register with Pancreatic Cancer North America in the meantime while the requisition form is being completed.
Alberta Requisition Form
British Columbia Requisition Form
Manitoba Requisition Form
Newfoundland and Labrador Requisition Form
Northwest Territories Requisition Form
Nova Scotia Requisition Form
Nunavut Requisition Form
Ontario Requisition Form
Prince Edward Island Requisition Form
Quebec Requisition Form
Saskatchewan Requisition Form
Yukon Requisition Form
Please note: Patients in New Brunswick are not eligible for this program, as a comprehensive publicly funded testing panel is already available.