Requisition Form
SCSA® Diagnostics, Inc. will accept a standard order from the attending physician or the Sperm Chromatin Structure Assay (SCSA®) Requisition Form below. The requisition may be returned in the shipment with the semen sample or emailed to orders@scsatest.com. The Requisition Form may be sent after the sample has been received and analyzed, but results won't be released until we have the Requisition Form.
PATIENT INFORMATION
CLINIC INFORMATION

