A needs assessment across 24 DCM Consortium sites revealed four distinct care models for genetic evaluation of dilated cardiomyopathy patients, ranging from traditional synchronous approaches requiring the most time per patient to physician-conducted models requiring the least. While all sites used genetic testing, 88% of principal investigators reported using genetic information for critical treatment decisions including ICD placement and cardiac transplant eligibility. Traditional models scored higher on acceptability ratings compared to physician-conducted approaches. This variability in genetic care delivery represents a significant gap in standardized cardiovascular medicine. The finding highlights how genetic information increasingly drives high-stakes cardiac interventions, yet delivery remains fragmented without established best practices. For patients with inherited cardiomyopathy, this inconsistency could mean vastly different access to genetic counseling and family screening depending on their care location. The study identifies key barriers including personnel limitations and reimbursement challenges, while facilitators include having dedicated genetic counselors on heart failure teams. As this is a preprint awaiting peer review, these practice patterns may evolve as the field develops more standardized approaches to genetic cardiology care.