DNA Testing Information Form
Please complete the information below.
Primary Participant Name (Exactly as it appears on your photo ID)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Female
Male
Test Type
*
Paternity (includes 1 alleged father & 1 child)
Maternity
Grandparentage (includes 1 parent & 1 child)
Name of Alleged Father/Mother #1
*
*If Mother/Father is deceased, put N/A
Have you had a Blood Transfusion in the past 30 days?
*
YES
NO
Child's Name
*
First Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
Date
Child's Gender
*
Female
Male
Has the child had a Blood Transfusion in the past 30 days?
*
YES
NO
Do you understand that the total costs of the tests will be billed today?
*
YES
NO
No refunds. No chargebacks. Do you understand this policy?
*
YES
NO
Do you understand that results are sent to the person who purchases the test?
*
YES
NO
Signature
*
Continue
Continue
Should be Empty: