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PARTICIPATE in a screening programme | Familial Hypercholesterolaemia Screening
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FH kit (FH Auckland Labplus endorsed) $70.00 NZD
Self-paying (Kit + Analysis) $800.00 NZD
includes GST
First Name
*
Last Name
*
Date of birth (DD/MM/YY)
*
NHI number (if known)
*
Ethnicity
*
African
European
Hispanic
Indian
Maori
Samoan
South East Asian
Tongan
GP Name
*
GP address
*
Arcus cornealis at age <45 yrs
*
Yes
No
First degree relative with known premature coronary and/or vascular disease, OR First degree relative with LDL cholesterol >95th Centile for age and sex
*
Yes
No
First degree relative with tendon xanthomata and/or arcus cornealis OR Children <18yr with LDL >95th percentile for age & sex
*
Yes
No
LDL Cholesterol
*
Premature cerebral or peripheral vascular disease (men <55, women <60yr)
*
Yes
No
Premature coronary artery disease (men <55, women <60yr)
*
Yes
No
Tendon xanthomata
*
Yes
No
Option:
FH kit (FH Auckland Labplus endorsed) $70.00 NZD
Self-paying (Kit + Analysis) $800.00 NZD
Quantity:
Contact us for more info, price or availability