Request Testing from our Telehealth Provider

Complete the below test form to request testing from our telehealth provider. Please note the MAR-Autism test is not validated for women who are currently pregnant or under the age of 18. You must also currently have a child that is symptomatic or diagnosed with autism. Please have a government-issued photo ID available, as you will be asked to upload a photo of the front of your ID.

MARAbio is unable to accept specimens collected within the state of New York. Travel for a blood draw may be required. If you have questions about this process, please call (844) 423-6272 or email support@marabio.com.

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* 1. Name

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* 2. Email

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* 3. Phone (XXX-XXX-XXXX)

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* 4. Date of Birth (MM/DD/YYYY)

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* 5. What is your birth sex?

Female

Male

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* 6. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

White

Self-describe below: