{"id":1758,"date":"2025-11-22T14:10:08","date_gmt":"2025-11-22T14:10:08","guid":{"rendered":"https:\/\/www.axesome.com\/patient-sample-application-form\/"},"modified":"2025-11-27T12:58:35","modified_gmt":"2025-11-27T12:58:35","slug":"patient-sample-application-form","status":"publish","type":"page","link":"https:\/\/www.axesome.com\/en\/patient-sample-application-form\/","title":{"rendered":"Patient Sample Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1758\" class=\"elementor elementor-1758 elementor-1389\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-10d2e5c e-flex e-con-boxed e-con e-parent\" data-id=\"10d2e5c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-c925386 e-con-full e-flex e-con e-child\" data-id=\"c925386\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1089c1f elementor-widget elementor-widget-image\" data-id=\"1089c1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"500\" height=\"50\" src=\"https:\/\/www.axesome.com\/wp-content\/uploads\/2025\/11\/genoscope-logo.png\" class=\"attachment-large size-large wp-image-1615\" alt=\"\" srcset=\"https:\/\/www.axesome.com\/wp-content\/uploads\/2025\/11\/genoscope-logo.png 500w, https:\/\/www.axesome.com\/wp-content\/uploads\/2025\/11\/genoscope-logo-300x30.png 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0465837 elementor-widget elementor-widget-heading\" data-id=\"0465837\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Patient Sample Application Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e5d7b3 elementor-widget elementor-widget-text-editor\" data-id=\"2e5d7b3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Personal Genetic Color Profile Determination \u2013 Skin Sample Collection and Registration Form<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-01a5a6c genoscope-form elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"01a5a6c\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"numune_radio, numune_diger_text\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"patient_sample\" aria-label=\"patient_sample\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1758\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"01a5a6c\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Patient Sample Application Form - Axesome\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1758\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t<h2>Patient Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a57d633 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a57d633\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFull Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a57d633]\" id=\"form-field-field_a57d633\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_fda66b6 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fda66b6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tID Number \/ Passport Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_fda66b6]\" id=\"form-field-field_fda66b6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"ID Number\" required=\"required\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b045670 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b045670\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact (Phone \/ Email)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b045670]\" id=\"form-field-field_b045670\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Phone or Email Address\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_45a931b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_45a931b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tApplication Date\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_45a931b]\" id=\"form-field-field_45a931b\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_af6854b elementor-col-100\">\n\t\t\t\t\t<h2>Doctor Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_7fae612 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7fae612\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFull Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7fae612]\" id=\"form-field-field_7fae612\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9042e08 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9042e08\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSpecialty\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9042e08]\" id=\"form-field-field_9042e08\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Your Specialty\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ee69780 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ee69780\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAffiliated Institution\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ee69780]\" id=\"form-field-field_ee69780\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Institution Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_2d1590a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2d1590a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSignature \/ Stamp\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_2d1590a]\" id=\"form-field-field_2d1590a\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4b68622 elementor-col-100\">\n\t\t\t\t\t<h2>Sample Collection Information<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d0ea8ad elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d0ea8ad\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCollection Method\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Swab Method from Skin Surface (Dermaroller \/ Micro-needle device)\" id=\"form-field-field_d0ea8ad-0\" name=\"form_fields[field_d0ea8ad]\" required=\"required\"> <label for=\"form-field-field_d0ea8ad-0\">Swab Method from Skin Surface (Dermaroller \/ Micro-needle device)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Stratum Corneum Adhesive Tape Method (Tape-Strip)\" id=\"form-field-field_d0ea8ad-1\" name=\"form_fields[field_d0ea8ad]\" required=\"required\"> <label for=\"form-field-field_d0ea8ad-1\">Stratum Corneum Adhesive Tape Method (Tape-Strip)<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7f58b70 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7f58b70\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSample Collection Area\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Forehead\" id=\"form-field-field_7f58b70-0\" name=\"form_fields[field_7f58b70]\" required=\"required\"> <label for=\"form-field-field_7f58b70-0\">Forehead<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Cheek\" id=\"form-field-field_7f58b70-1\" name=\"form_fields[field_7f58b70]\" required=\"required\"> <label for=\"form-field-field_7f58b70-1\">Cheek<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Arm\" id=\"form-field-field_7f58b70-2\" name=\"form_fields[field_7f58b70]\" required=\"required\"> <label for=\"form-field-field_7f58b70-2\">Arm<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Other\" id=\"form-field-field_7f58b70-3\" name=\"form_fields[field_7f58b70]\" required=\"required\"> <label for=\"form-field-field_7f58b70-3\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_617f75e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_617f75e]\" id=\"form-field-field_617f75e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Other Area\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_22ca98b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_22ca98b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCollection Date\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_22ca98b]\" id=\"form-field-field_22ca98b\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-time elementor-field-group elementor-column elementor-field-group-field_ad0677e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ad0677e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCollection Time\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"time\" name=\"form_fields[field_ad0677e]\" id=\"form-field-field_ad0677e\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-time-field\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b0edd0b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b0edd0b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSample Code Alias \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b0edd0b]\" id=\"form-field-field_b0edd0b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Sample Code Alias \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_382b35a elementor-col-100\">\n\t\t\t\t\t<h2>Sample Shipment<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_e9ede4e elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e9ede4e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tShipment Date\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_e9ede4e]\" id=\"form-field-field_e9ede4e\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_83489ba elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_83489ba\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSender\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_83489ba]\" id=\"form-field-field_83489ba\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Sender Full Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ab01568 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ab01568\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCourier \/ Delivery Company Information\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ab01568]\" id=\"form-field-field_ab01568\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Courier Information\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_05d00a4 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_05d00a4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTracking Number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_05d00a4]\" id=\"form-field-field_05d00a4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tracking Number\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_73577f1 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"&lt;p style=&#039;font-size:15px;&#039;&gt;As the undersigned, I consent to the use of my skin sample for genetic (DNA\/RNA) analysis, the sharing of analysis results only with my authorized doctor, and the extraction of my genetic color profile within the scope of Genoscope.\" id=\"form-field-field_73577f1-0\" name=\"form_fields[field_73577f1]\" required=\"required\"> <label for=\"form-field-field_73577f1-0\"><p style='font-size:15px;'>As the undersigned, I consent to the use of my skin sample for genetic (DNA\/RNA) analysis, the sharing of analysis results only with my authorized doctor, and the extraction of my genetic color profile within the scope of Genoscope.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e018f4f elementor-col-100 elementor-field-required\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"I have read and accept the &lt;a href=&quot;https:\/\/www.axesome.com\/en\/kvkk-clarification-text\/&quot; target=&quot;_blank&quot;&gt;KVKK Clarification Text&lt;\/a&gt;. \" id=\"form-field-field_e018f4f-0\" name=\"form_fields[field_e018f4f]\" required=\"required\"> <label for=\"form-field-field_e018f4f-0\">I have read and accept the <a href=\"https:\/\/www.axesome.com\/en\/kvkk-clarification-text\/\" target=\"_blank\">KVKK Clarification Text<\/a>. <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_15f4ba9 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_15f4ba9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFull Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_15f4ba9]\" id=\"form-field-field_15f4ba9\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Full Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_6cdcefc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6cdcefc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_6cdcefc]\" id=\"form-field-field_6cdcefc\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_d41df4b elementor-col-100\">\n\t\t\t\t\tNote: The sample must be stored under sterile conditions at the appropriate temperature and delivered to the Genoscope Analysis Center within eight hours at the latest. Delayed shipments will be subject to quality control.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Sample Application Form Personal Genetic Color Profile Determination \u2013 Skin Sample Collection and Registration Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1758","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages\/1758","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/comments?post=1758"}],"version-history":[{"count":1,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages\/1758\/revisions"}],"predecessor-version":[{"id":1759,"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/pages\/1758\/revisions\/1759"}],"wp:attachment":[{"href":"https:\/\/www.axesome.com\/en\/wp-json\/wp\/v2\/media?parent=1758"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}