Dr. Pierluigi Gambetti, Director
National Prion Disease Pathology Surveillance Center
Institute of Pathology
Room 419, Case Western Reserve University
2085 Adelbert Road
Cleveland, OH 44106

Dear Dr. Gambetti:

I am requesting a genetic blood test for mutations in the PRNP gene.  I have enclosed a sample of my blood for that testing.

I do not wish to know my result at this time.  Please keep the result on file and if I wish to know my result at a future time, I will send a letter indicating it be sent to my physician.

Thank you for your assistance in this matter.

Sincerely,

Jane Doe

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