Request for electronic records

INFORMED CONSENT FOR ELECTRONIC DELIVERY OF DNA TEST RESULTS

Universal Genetics / Advanced Genetics - AABB Accredited DNA Testing Laboratories

1. Purpose of this Consent
I, {namesOf}, hereby authorize Universal Genetics / Advanced Genetics to send my DNA test results to the email address I have provided in this form. I understand that this consent is required due to privacy policies that limit the electronic transmission of sensitive records.

2. Acknowledgment and Agreement
By signing this consent form, I acknowledge and agree to the following:

I voluntarily request Universal Genetics / Advanced Genetics to send my DNA test results electronically to the email address specified above.

I understand that email is not a fully secure communication method, and I accept any associated risks.

I acknowledge that Universal Genetics / Advanced Genetics is not responsible for any unauthorized access, loss, or interception of the emailed results once they are sent to the provided address.

I understand that I am solely responsible for the security and privacy of the results upon receipt.

I release Universal Genetics / Advanced Genetics, its employees, representatives, and affiliates from any liability, claim, or damages resulting from the electronic transmission of my DNA test results.

I confirm that I am the legal recipient of the test results and that the information I have provided is accurate.

3. Client Identification Requirement
For identity verification, I have attached a clear and valid copy of my government-issued ID (passport, driver’s license, or national ID).

4. Revocation of Consent
I understand that I may revoke this consent in writing at any time before the results are sent. Once the results are transmitted, this consent is irrevocable.

5. Consent and Signature
I certify that I have read and understood this consent form. I agree to the terms outlined above and confirm that I am providing this authorization voluntarily.

Next, we will needd you to provide a selfie/photos as well as copies of the IDs or Driver Licenses (DLs) for all the relevant people mentioned in this form.

📸 How to Take and Upload Your Photos
To ensure smooth processing, please follow these guidelines when taking your selfie and ID photos.

1️⃣ Taking a Clear Selfie for Identity Verification

✅ DO:

• Stand in a well-lit area.
• Look straight at the camera with a neutral expression.
• Remove hats, sunglasses, or anything covering your face.
• Ensure the background is plain (white or light-colored is best).

❌ DON’T:

• Avoid blurry or pixelated images.
• Do not use filters or edits.
• No group photos or someone else in the frame.

2️⃣ Taking a Photo of Your Identification (ID)

✅ DO:

• Place the ID on a flat surface with good lighting.
• Ensure the entire ID is visible and not cropped.
• Remove any glare or reflections on the plastic.
• Make sure the details are readable.

❌ DON’T:

• Do not take a photo with a strong glare.
• Avoid blurry or dark images.
• Do not cover any part of your ID.

3️⃣ Taking a Photo of Yourself Holding Your ID

✅ DO:

• Hold your ID next to your face.
• Make sure both your face and ID are clear.
• Keep the image well-lit and without shadows.

❌ DON’T:

• Do not cover any part of the ID with your fingers.
• Avoid taking photos in dim lighting.

🔄 Final Step: If you upload your photos from your computer make sure:

• File format is JPEG, PNG, or PDF.
• The file size is not too large to avoid upload issues.

EXAMPLES: