{"id":15358,"date":"2026-09-11T09:21:27","date_gmt":"2026-09-11T07:21:27","guid":{"rendered":"https:\/\/www.worldhealthlaboratories.com\/?page_id=15358"},"modified":"2026-09-11T09:44:21","modified_gmt":"2026-09-11T07:44:21","slug":"isari-request-form","status":"publish","type":"page","link":"https:\/\/www.worldhealthlaboratories.com\/nl\/isari-request-form\/","title":{"rendered":"WHL ISARI-AANVRAAGFORMULIER"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"15358\" class=\"elementor elementor-15358\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c713fe5 e-flex e-con-boxed e-con e-parent\" data-id=\"c713fe5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-75e74ee elementor-widget elementor-widget-shortcode\" data-id=\"75e74ee\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style>\n.whl-isari{--ink:#19161b;--muted:#6f6972;--line:#e6e0e4;--rose:#9f4567;--rose2:#7e3152;--soft:#faf6f8;--mint:#eef8f2;max-width:1180px;margin:auto;color:var(--ink);font-family:Arial,Helvetica,sans-serif;line-height:1.45}\n.whl-isari *{box-sizing:border-box}.isari-hero{padding:28px;border:1px solid var(--line);border-radius:22px;background:linear-gradient(135deg,#fbf3f6,#f4f9f6);margin-bottom:18px}\n.isari-eyebrow{font-size:12px;font-weight:800;letter-spacing:.12em;text-transform:uppercase;color:var(--rose)}.isari-hero h1{font-size:32px;margin:7px 0 8px}.isari-hero p{max-width:800px;color:#514b53;margin:0}\n.tasso{margin-top:15px;padding:13px;border:1px solid #cfe5d7;border-radius:13px;background:#fff;display:flex;gap:10px;align-items:flex-start}.tasso b{background:var(--mint);padding:5px 9px;border-radius:999px;color:#276a50;font-size:12px;white-space:nowrap}\n.layout{display:grid;grid-template-columns:1fr;gap:18px}@media(min-width:1030px){.layout{grid-template-columns:minmax(0,1fr) 350px}.side{position:sticky;top:18px;align-self:start}}\n.card{background:#fff;border:1px solid var(--line);border-radius:18px;padding:20px;margin-bottom:16px}.card h2{margin:0 0 7px;font-size:21px}.help{font-size:13px;color:var(--muted);margin:0 0 12px}\n.row{display:grid;grid-template-columns:1fr;gap:11px}@media(min-width:700px){.row.two{grid-template-columns:1fr 1fr}.row.three{grid-template-columns:1fr 1fr 1fr}}\n.field{display:block;font-weight:700;margin:10px 0 5px}.req:after{content:\" *\";color:#b42318}\n.row>div,.name-block{min-width:0}.whl-isari input:not([type=checkbox]):not([type=radio]):not([type=submit]),.whl-isari select,.whl-isari textarea{display:block;width:100%!important;max-width:100%!important;min-width:0!important;min-height:46px!important;padding:11px 12px;border:1px 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7px;border-radius:999px;font-size:11px;font-weight:800}.panel details{margin:10px 0 0 24px}.panel summary{cursor:pointer;color:var(--rose);font-weight:800;font-size:13px}.panel ul{font-size:13px;color:#575159;margin:7px 0 0 18px;padding:0}.sex-marker{font-weight:800;color:var(--rose2)}\n.addon-group{border:1px solid var(--line);border-radius:13px;margin:10px 0;overflow:hidden}.addon-group h3{margin:0;padding:10px 12px;background:var(--soft);font-size:15px}.addon-grid{display:grid;grid-template-columns:1fr;gap:7px;padding:11px}@media(min-width:720px){.addon-grid{grid-template-columns:1fr 1fr}}\n.addon{display:flex;gap:8px;align-items:flex-start;padding:9px;border:1px solid #eee9ec;border-radius:10px;cursor:pointer}.addon:has(input:checked){border-color:#c98aa3;background:#fff8fb}\n.summary{white-space:pre-wrap;background:#19171c;color:#fff;border-radius:13px;padding:13px;font-family:Consolas,monospace;font-size:12px;min-height:250px}.actions{display:flex;gap:9px;flex-wrap:wrap;margin-top:15px}.btn{border:0;border-radius:10px;padding:12px 15px;font-weight:800;cursor:pointer}.primary{background:var(--rose);color:white}.secondary{background:#eee9ec}.female-only,.male-only{display:list-item}.sex-female .male-only{display:none!important}.sex-male .female-only{display:none!important}.data-use-note{background:#f7f5f7;border:1px solid var(--line);border-radius:11px;padding:12px;font-size:13px;color:#575159}.success{padding:13px;background:#ecfdf3;border:1px solid #abefc6;color:#067647;border-radius:13px;margin-bottom:15px}.error{padding:13px;background:#fef3f2;border:1px solid #fecdca;color:#b42318;border-radius:13px;margin-bottom:15px}.hp{position:absolute;left:-9999px}\n<\/style>\n<div class=\"whl-isari\">\n<div class=\"isari-hero\">\n<div class=\"isari-eyebrow\">ISARI \u00d7 World Health Laboratories<\/div>\n<h1>ISARI Test Order<\/h1>\n<p>A simple practitioner ordering page for ISARI. Enter the requesting practitioner and patient details, then choose Core or Extended. Sex-specific biomarkers are applied automatically.<\/p>\n<div class=\"tasso\"><b>HOME COLLECTION<\/b><span><strong>Tasso is used for compatible blood tests.<\/strong><br><small>If another specimen or collection material is required for a selected test, WHL will include the appropriate materials and instructions with the kit.<\/small><\/span><\/div>\n<\/div>\n\n\n<form method=\"post\" action=\"https:\/\/www.worldhealthlaboratories.com\/nl\/isari-request-form\/\">\n<input type=\"hidden\" name=\"whl_isari_submit\" value=\"1\">\n<input type=\"hidden\" id=\"whl_isari_nonce\" name=\"whl_isari_nonce\" value=\"0ab5196da0\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nl\/wp-json\/wp\/v2\/pages\/15358\" \/><div class=\"hp\"><input name=\"website_url\" tabindex=\"-1\" autocomplete=\"off\"><\/div>\n\n<div class=\"layout\"><main>\n<div class=\"card\">\n<h2>1. Practitioner<\/h2><p class=\"help\">ISARI can use different clinicians; enter the practitioner responsible for this request.<\/p>\n<div class=\"name-block\"><label class=\"field req\">Practitioner name<\/label><input class=\"large-name\" id=\"practitioner_name\" name=\"practitioner_name\" required placeholder=\"Full name\"><\/div>\n<div class=\"name-block\"><label class=\"field\">Practitioner email<\/label><input id=\"practitioner_email\" name=\"practitioner_email\" type=\"email\" placeholder=\"Optional\"><\/div>\n<div class=\"row two\"><div><label class=\"field\">Order type<\/label><select id=\"order_type\" name=\"order_type\"><option>Initial baseline<\/option><option>3-month retest<\/option><option>HRT follow-up<\/option><option>TRT follow-up<\/option><option>Weight-management follow-up<\/option><option>Other follow-up<\/option><\/select><\/div>\n<div><label class=\"field\">Clinical pathway<\/label><select id=\"clinical_pathway\" name=\"clinical_pathway\"><option>General midlife health<\/option><option>Perimenopause<\/option><option>Menopause \/ HRT<\/option><option>Low testosterone \/ TRT<\/option><option>Weight loss \/ GLP-1<\/option><option>Body recomposition<\/option><option>Hair health<\/option><option>Other<\/option><\/select><\/div><\/div>\n<\/div>\n\n<div class=\"card\"><h2>2. Patient & collection kit shipment<\/h2>\n<div class=\"name-block\"><label class=\"field req\">Patient name<\/label><input class=\"large-name\" id=\"patient_name\" name=\"patient_name\" required placeholder=\"First name and surname\"><\/div>\n<div class=\"row two\"><div><label class=\"field req\">Date of birth<\/label><input id=\"date_of_birth\" class=\"date-text\" name=\"date_of_birth\" type=\"text\" inputmode=\"numeric\" placeholder=\"DD-MM-YYYY\" pattern=\"^(0[1-9]|[12][0-9]|3[01])[-\/](0[1-9]|1[0-2])[-\/](19|20)\\d\\d$\" required><small class=\"help\">Format: DD-MM-YYYY<\/small><\/div><div><\/div><\/div>\n<label class=\"field req\">Sex at birth<\/label><div class=\"sexes\"><label class=\"choice\"><input type=\"radio\" name=\"sex_at_birth\" value=\"female\" required> Female<\/label><label class=\"choice\"><input type=\"radio\" name=\"sex_at_birth\" value=\"male\" required> Male<\/label><\/div>\n<div class=\"row two\"><div><label class=\"field req\">Email<\/label><input id=\"patient_email\" name=\"patient_email\" type=\"email\" required placeholder=\"name@example.com\"><\/div><div><label class=\"field req\">Telephone<\/label><input id=\"telephone\" name=\"telephone\" type=\"tel\" required placeholder=\"+31 ...\"><\/div><\/div>\n<label class=\"field req\">Shipping address<\/label><input id=\"address\" name=\"address\" type=\"text\" required placeholder=\"Street and house number\">\n<div class=\"row three\"><div><label class=\"field req\">Zipcode<\/label><input id=\"zipcode\" name=\"zipcode\" type=\"text\" required placeholder=\"1234 AB\"><\/div><div><label class=\"field req\">City<\/label><input id=\"city\" name=\"city\" type=\"text\" required placeholder=\"City\"><\/div><div><label class=\"field req\">Country<\/label><input id=\"country\" name=\"country\" type=\"text\" value=\"Netherlands\" required><\/div><\/div>\n<\/div>\n\n<div class=\"card\"><h2>3. Select ISARI package<\/h2><p class=\"help\" id=\"sex_status\">Select sex at birth to show the correct sex-specific variant.<\/p>\n<div class=\"panels\">\n<div class=\"panel\" id=\"card_core\"><span class=\"tag\">Focused baseline<\/span><h3>Core<\/h3><label class=\"choice\" style=\"margin-top:10px\"><input type=\"radio\" name=\"panel\" value=\"core\" required> Select Core<\/label><details><summary>View included biomarkers<\/summary><ul id=\"core_list\">\n<li>Estradiol (sensitive assay)<\/li>\n<li>Progesterone<\/li>\n<li>Total testosterone<\/li>\n<li>SHBG<\/li>\n<li>Calculated free testosterone<\/li>\n<li>TSH<\/li>\n<li>Free T4<\/li>\n<li>Free T3<\/li>\n<li>hs-CRP<\/li>\n<li>Fasting insulin<\/li>\n<li class=\"female-only sex-marker\">Ferritin \u2014 female variant only<\/li>\n<li class=\"male-only sex-marker\">PSA \u2014 male variant only<\/li>\n<\/ul><\/details><\/div>\n<div class=\"panel\" id=\"card_extended\"><span class=\"tag\">Deeper assessment<\/span><h3>Extended<\/h3><label class=\"choice\" style=\"margin-top:10px\"><input type=\"radio\" name=\"panel\" value=\"extended\" required> Select Extended<\/label><details><summary>View included biomarkers<\/summary><ul id=\"ext_list\">\n<li>Estradiol (sensitive assay)<\/li>\n<li>Progesterone<\/li>\n<li>Total testosterone<\/li>\n<li>SHBG<\/li>\n<li>Calculated free testosterone<\/li>\n<li>TSH<\/li>\n<li>Free T4<\/li>\n<li>Free T3<\/li>\n<li>hs-CRP<\/li>\n<li>Fasting insulin<\/li>\n<li>Ferritin<\/li>\n<li>FSH<\/li>\n<li>LH<\/li>\n<li>DHEA-S<\/li>\n<li>Total cholesterol<\/li>\n<li>LDL cholesterol<\/li>\n<li>HDL cholesterol<\/li>\n<li>Triglycerides<\/li>\n<li>TC:HDL ratio<\/li>\n<li>HbA1c<\/li>\n<li>Vitamin B12<\/li>\n<li>ALT (ALAT)<\/li>\n<li>Creatinine<\/li>\n<li>eGFR<\/li>\n<li class=\"male-only sex-marker\">PSA \u2014 male variant only<\/li>\n<\/ul><\/details><\/div>\n<\/div>\n<p class=\"help\" style=\"margin-top:12px\"><strong>Sex-specific logic:<\/strong> Core uses Ferritin for the female variant and PSA for the male variant. Extended includes Ferritin for both and PSA only for the male variant. Fasting insulin is included in both packages.<\/p>\n<\/div>\n\n<div class=\"card\"><h2>4. Optional related tests<\/h2><p class=\"help\">These are relevant to ISARI's hormone, metabolic, body-composition and treatment-monitoring pathways. Tasso is used when compatible with the selected blood test. If another collection material or specimen is required, WHL will include it with the home collection kit.<\/p>\n<div class=\"addon-group\"><h3>Metabolic & cardiovascular<\/h3><div class=\"addon-grid\">\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"glucose_homa\"> Fasting glucose + HOMA-IR<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"apob_lpa\"> ApoB + Lipoprotein(a)<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"vitd\"> Vitamin D (25-OH)<\/label>\n<\/div><\/div>\n<div class=\"addon-group\"><h3>Hormone & thyroid<\/h3><div class=\"addon-grid\">\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"prolactin\"> Prolactin<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"igf1\"> IGF-1<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"cortisol\"> Morning cortisol<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"thyroid_ab\"> Anti-TPO + Anti-thyroglobulin antibodies<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"reverse_t3\"> Reverse T3<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"dht\"> DHT<\/label>\n<\/div><\/div>\n<div class=\"addon-group\"><h3>Monitoring & nutrients<\/h3><div class=\"addon-grid\">\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"cbc\"> Hematology + differential \/ hematocrit<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"iron\"> Iron status<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"folate\"> Folate<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"magnesium\"> Magnesium<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"zinc\"> Zinc<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"selenium\"> Selenium<\/label>\n<\/div><\/div>\n<div class=\"addon-group\"><h3>Liver, kidney & electrolytes<\/h3><div class=\"addon-grid\">\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"liver\"> Expanded liver profile<\/label>\n<label class=\"addon\"><input type=\"checkbox\" name=\"addons[]\" value=\"electrolytes\"> Electrolytes & minerals<\/label>\n<\/div><\/div>\n<\/div>\n\n<div class=\"card\"><h2>5. Clinical information<\/h2>\n<label class=\"field\">Medication \/ HRT \/ TRT \/ GLP-1 \/ supplements<\/label><textarea id=\"medication\" name=\"medication\"><\/textarea>\n<label class=\"field\">Clinical notes<\/label><textarea id=\"clinical_notes\" name=\"clinical_notes\"><\/textarea>\n<label class=\"field\">Additional remarks<\/label><textarea id=\"additional\" name=\"additional\"><\/textarea>\n<div class=\"data-use-note\" style=\"margin-top:13px\"><strong>Patient data use:<\/strong> WHL uses the patient contact and address details from this form only to prepare and send the requested collection kit and coordinate sample logistics. WHL will not use this form to contact the patient for payment or to deliver results.<\/div>\n<div class=\"actions\"><button class=\"btn primary\" type=\"submit\">Submit ISARI order to WHL<\/button><button class=\"btn secondary\" type=\"button\" id=\"copy_summary\">Copy order summary<\/button><\/div>\n<div id=\"copy_status\" class=\"help\"><\/div>\n<\/div>\n<\/main>\n\n<aside class=\"side\"><div class=\"card\"><h2>Order summary<\/h2><p class=\"help\">The WHL email contains the exact panel variant and selected add-ons.<\/p><div class=\"summary\" id=\"order_summary\"><\/div><\/div><\/aside>\n<\/div><\/form><\/div>\n\n<script>\n(function(){\nconst core=[\"Estradiol (sensitive assay)\",\"Progesterone\",\"Total testosterone\",\"SHBG\",\"Calculated free testosterone\",\"TSH\",\"Free T4\",\"Free T3\",\"hs-CRP\",\"Fasting insulin\"];\nconst ext=[\"Estradiol (sensitive assay)\",\"Progesterone\",\"Total testosterone\",\"SHBG\",\"Calculated free testosterone\",\"TSH\",\"Free T4\",\"Free T3\",\"hs-CRP\",\"Fasting insulin\",\"Ferritin\",\"FSH\",\"LH\",\"DHEA-S\",\"Total cholesterol\",\"LDL cholesterol\",\"HDL cholesterol\",\"Triglycerides\",\"TC:HDL ratio\",\"HbA1c\",\"Vitamin B12\",\"ALT (ALAT)\",\"Creatinine\",\"eGFR\"];\nconst amap={\"glucose_homa\":\"Fasting glucose + calculated HOMA-IR\",\"apob_lpa\":\"ApoB + Lipoprotein(a)\",\"vitd\":\"Vitamin D (25-OH)\",\"prolactin\":\"Prolactin\",\"igf1\":\"IGF-1\",\"cortisol\":\"Morning cortisol\",\"thyroid_ab\":\"Anti-TPO + Anti-thyroglobulin antibodies\",\"reverse_t3\":\"Reverse T3\",\"dht\":\"Dihydrotestosterone (DHT)\",\"cbc\":\"Hematology + differential (CBC, including hematocrit)\",\"iron\":\"Iron status (iron, ferritin, TIBC, transferrin)\",\"folate\":\"Folate\",\"magnesium\":\"Magnesium\",\"zinc\":\"Zinc\",\"selenium\":\"Selenium\",\"liver\":\"Expanded liver profile (AST, ALP, bilirubin, albumin, total protein)\",\"electrolytes\":\"Electrolytes & minerals (Na, K, Cl, bicarbonate, calcium)\"};\nfunction v(id){const e=document.getElementById(id);return e?(e.value||'').trim():''}\nfunction sx(){const e=document.querySelector('input[name=\"sex_at_birth\"]:checked');return e?e.value:''}\nfunction pn(){const e=document.querySelector('input[name=\"panel\"]:checked');return e?e.value:''}\nfunction markers(panel,sex){let x=(panel==='extended'?ext:core).slice();if(panel==='core'){if(sex==='female')x.push('Ferritin (female variant)');if(sex==='male')x.push('PSA (male variant)')}else{if(sex==='male')x.push('PSA (male variant)')}return x}\nfunction render(){\n const s=sx();\n document.querySelector('.whl-isari').classList.remove('sex-female','sex-male');\n if(s) document.querySelector('.whl-isari').classList.add(s==='female'?'sex-female':'sex-male');\n document.getElementById('sex_status').textContent=s?('Selected variant: '+(s==='female'?'Female':'Male')):'Select sex at birth to show the correct sex-specific variant.';\n document.querySelectorAll('.panel').forEach(x=>x.classList.remove('selected'));if(pn())document.getElementById('card_'+pn()).classList.add('selected');\n const ads=Array.from(document.querySelectorAll('input[name=\"addons[]\"]:checked')).map(x=>amap[x.value]);\n const ms=pn()?markers(pn(),s):[];\n document.getElementById('order_summary').textContent=[\n 'WHL TEST ORDER \u2014 ISARI',\n '',\n 'Practitioner: '+v('practitioner_name'),\n 'Practitioner email: '+v('practitioner_email'),\n 'Order type: '+v('order_type'),\n 'Clinical pathway: '+v('clinical_pathway'),\n '',\n 'Patient: '+v('patient_name'),\n 'Sex at birth: '+(s?(s==='female'?'Female':'Male'):''),\n 'DOB: '+v('date_of_birth'),\n 'Email: '+v('patient_email'),\n 'Telephone: '+v('telephone'),\n 'Address: '+v('address')+', '+v('zipcode')+' '+v('city')+', '+v('country'),\n '',\n 'Collection: Home collection \u2014 Tasso for compatible blood tests; other kit materials when required',\n '',\n 'Panel: '+(pn()?(pn()==='core'?'ISARI Core':'ISARI Extended'):''),\n ms.length?ms.map(x=>'- '+x).join('\\n'):'- Select a panel',\n '',\n 'Add-ons:',\n ads.length?ads.map(x=>'- '+x).join('\\n'):'- None',\n '',\n 'Medication: '+(v('medication')||'-'),\n 'Clinical notes: '+(v('clinical_notes')||'-'),\n 'Additional: '+(v('additional')||'-')\n ].join('\\n');\n}\ndocument.addEventListener('DOMContentLoaded',function(){\n document.querySelectorAll('.whl-isari input,.whl-isari select,.whl-isari textarea').forEach(e=>{e.addEventListener('change',render);e.addEventListener('keyup',render)});\n document.getElementById('copy_summary').addEventListener('click',function(){navigator.clipboard.writeText(document.getElementById('order_summary').textContent).then(()=>document.getElementById('copy_status').textContent='Summary copied.')});\n render();\n});\n})();\n<\/script>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-15358","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/pages\/15358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/comments?post=15358"}],"version-history":[{"count":4,"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/pages\/15358\/revisions"}],"predecessor-version":[{"id":15369,"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/pages\/15358\/revisions\/15369"}],"wp:attachment":[{"href":"https:\/\/www.worldhealthlaboratories.com\/nl\/wp-json\/wp\/v2\/media?parent=15358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}