DNA Testing Request

  • DNA Testing Request

  • Format: (000) 000-0000.
  • Are you also the authorized recipient of the test results?*

  • Authorized Results Recipient

    Test results will ONLY be released to the individual(s) listed below. This may be you or third party (employer, attorney, court, agency, etc.).
  • Format: (000) 000-0000.
  • Type of DNA Test Requested*
  • Purpose of Testing*
  • Participant #1 Role*
  • Participant #1 Date of Birth*
     / /
  • Participant #2 Role*
  • Participant #2 Date of Birth*
     / /
  • Participant #3 Role
  • Participant #3 Date of Birth
     / /

  • *Pricing Disclosure Statement

    Additional participants not included in the selected service package will incur a $150 per-person fee. This amount will be added to the total balance and must be paid prior to scheduling.

  • Additional Participant #1 Role*
  • Additional Participant #1 Date of Birth*
     / /
  • Additional Participant #2 Role
  • Additional Participant #2 Date of Birth
     / /
  • Has any participant had a blood transfusion in the past 3 months?*
  • Select preferred appointment time windows*

  • *Evening and weekend appointments are subject to collector availability and may require an additional fee. If selected, we will contact you to confirm availability and pricing before scheduling.

  • Do you need a Mobile Collection? (additional fee may apply)*

  • Please review and acknowledge the following required consents to proceed with payment.

  • Today's Date*
     - -
  • Should be Empty: