DNA Testing Intake Form

Todays Date

Date

State

Name of Person Requesting Test

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Type of Test You're Requesting?

Please Choose One

Who Will Be Tested Today?

DIRECTIONS PRIOR TO TESTING: Prior to testing it is important that you (all participants) DO NOT brush teeth, drink, smoke, or eat ANYTHING 30 min before testing. INFANTS: Please DO NOT breastfeed or bottle feed one hour prior to testing.

By signing, I agree and understand that we have a NO REFUND policy. All services are final. You also understand that we are just the collection site, and all results come from an accredited AABB lab. In normal cases your results will come back within 3-5 business days once the lab receives the specimen. Williams Collection does not guarantee any specific result, and all results are released by email. Lastly, you understand and have been made aware that there are two kinds of test. A Legal Test which CAN be used in the court of law and the Non-Legal Peace of Mind Test that CANNOT be used for court.

Appointment

Mother's Name

First Name, MILast Name

Headshot picture

Email For Results

example@example.com

Date of Birth

Date

Gender

Race

Mom Signature

Childs Name

First Name, MILast Name

Headshot Photo

Email for Results (18 & over)

example@example.com

Date of Birth

Date

Gender

Race

Date

If under 18 legal guardian must sign for child

Alleged Father's Name

First Name, MILast Name

Headshot Photo

Email for Test Results (if applicable)

example@example.com

Date of Birth

Date

Gender

Race

Alleged Father (if applicable)

Additional Person Tested Name

First NameLast Name

Headshot Photo

Email for Results

example@example.com

Date of Birth

Date

Gender

Race

Additional Person Signature