DNA Testing Client Intake Form

🧬 DNA Testing Client Intake:
SECTION 1: Client Information (Person Completing)
Full Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Gender:*

MaleFemaleOther
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
SECTION 2: Test Type Requested
select all that apply*

Paternity TestMaternity TestSibling TestGrandparent TestImmigration TestLegal/Court-Admissible TestInformational Only (Non-legal)Other
SECTION 3: Participant Details

(List all people involved in the test)
Person #1:

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Gender:

MaleFemaleOther
Relationship to Other Participants (e.g., Alleged Father, Child)
Is this person available for a sample collection?

YesNo
Type of Sample (if not standard buccal swab):
Person #2:

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Gender:

MaleFemaleOther
Relationship to Other Participants (e.g., Alleged Father, Child)
Is this person available for a sample collection?

YesNo
Type of Sample (if not standard buccal swab):
Person #3:

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Gender:

MaleFemaleOther
Relationship to Other Participants (e.g., Alleged Father, Child)
Is this person available for a sample collection?

YesNo
Type of Sample (if not standard buccal swab):
SECTION 4: Legal/Consent Information
Is this test being performed under court order?*

YesNo
Are all adult participants aware of and consenting to the test?*

YesNo
Upload a Valid ID for each adult participant*

Browse Files

Cancelof
Upload Birth Certificate for minor participants (if applicable)

Browse Files

Cancelof
SECTION 5: Preferred Collection Method
Choose method:*

In-Office CollectionMobile Appointment (enter address below)At-Home Kit (shipped)Court Facility or Jail (enter facility info below)
Mobile Appointment Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Facility Info:
SECTION 6: Scheduling
Preferred Date of Appointment*

MonthDayYear
Preferred Time Range:*

Morning (9 AM - 12 PM)Afternoon (12 PM - 4 PM)Evening (4 PM - 7 PM)
SECTION 7: Payment
How will you be paying for the test?*

CashCredit/Debit CardOnline PaymentVoucher or Legal Agency
SECTION 8: Additional Notes
Please include any relevant case numbers, legal contacts, or special instructions:*
SECTION 9: Consent & Signature
Signature*

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Date of Submission*

MonthDayYear
Today's Date
Should be Empty:

🧬 DNA Testing Client Intake:

SECTION 1: Client Information (Person Completing)

SECTION 2: Test Type Requested

SECTION 3: Participant Details

SECTION 4: Legal/Consent Information

SECTION 5: Preferred Collection Method

SECTION 6: Scheduling

SECTION 7: Payment

SECTION 8: Additional Notes

SECTION 9: Consent & Signature