Analysis Form

Please fill the form below to send a sample to Physiotarget:

To download the Patient Consent Term, please, click here

    Physician Information

    Patient Information

    Specimen Information

    Patient Information

    Analysis Type

    Histopathological report


    Neoadjuvant Treatment

    Adjuvant Treatment

    Signed Consent Term

    Note: A digital signature is automatically generated when sending data by clicking on the “Send” button.
    This digital signature is sent to the physician’s email and must be associated with the specimen when mailing it for proper sample tracing.