Prolaris Ordering Process

  1. Physician completes the Prolaris Test Request Form and sends it to Myriad at, or fax to (801) 883-3256
  2. Myriad verifies insurance coverage and contacts the patient if the out-of-pocket cost will be more than $375. (View the Myriad PromiseTM for more info.)
  3. Myriad receives sample from pathology lab for testing
  4. Test results are sent to physician
  5. Physician and patient incorporate test results to make personalized treatment decisions

Prolaris Test Request Forms

Print, complete and return the appropriate Prolaris Test Request Form (below), and we will handle the rest.

Prolaris Biopsy Test Request Form

Prolaris Post-Prostatectomy Test Request Form

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