Non-Invasive Prenatal Paternity (NIPP)/Peekaboo Client Intake Form

Non-Invasive Prenatal Paternity (NIPP)/Peekaboo Client Intake Form
Section 1 - Service Selection
Which service are you requesting?*

Non-Invasive Prenatal Paternity (NIPP)Peekaboo Early Gender Detection
Section 2 - Client Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Secure Email Address*
example@example.com
Preferred Method of Contact*

PhoneEmail
City & State*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section 3 - Pregnancy Eligibility Questions
How many weeks pregnant are you?*
Is this a single baby pregnancy?*

YesNoUnsure
Have you had a recent blood transfusion or transplant?*

YesNoUnsure
Is the alleged father available for collection?*

YesNo
Section 4 - Participant Information
For NIPP:
Mother Full Name*

First NameLast Name
Alleged Father Full Name*

First NameLast Name
Photo ID*

YesNo
For Peekaboo:
Mother Full Name*

First NameLast Name
Photo ID*

YesNo
Section 5 - Collection Preferences
Preferred Collection Type*

Collection SiteMobile Collection (additional fee may apply)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Section 6 - Scheduling Availibility
Select preferred appointment time windows*

Morning (8:00 AM - 11:00 AM)Midday (11:00 AM - 2:00 PM)Afternoon (2:00 PM -4:00 PM)Evening (4:00 PM - 7:00 PM) Availability request (additional fee may apply)Saturday Morning (8:00 AM - 2:00 PM) Availability request (additional fee may apply)
Preferred Days*

MondayTuesdayWednesdayThursdayFridaySaturday Availability request (additional fee may apply)
*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.
Section 7 - Acknowledgements
Testing Coordination Acknowledgment*

I understand that Great Expansion Enterprise LLC coordinates testing services through partner laboratories and certified collection professionals. Submitting this form does not confirm an appointment or testing authorization. Payment and eligibility review are required before scheduling, and laboratory processing is managed by the testing laboratory.
Prenatal & Informational Testing Acknowledgment*

I acknowledge that prenatal testing services are informational and processed by third-party laboratories. Gestational age and eligibility requirements apply. Great Expansion Enterprise LLC does not provide medical advice, and I should consult my healthcare provider for medical concerns. Additional collections may be required based on laboratory review.
Electronic Communication & Secure Results DeliveryConsent*

I consent to receive scheduling updates, invoices, and secure result notifications by email, phone, or text message. Secure links or encrypted platforms may be used, and I am responsible for maintaining the privacy of my contact devices.
Signature

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Client Full Name*

First NameLast Name
Date*

MonthDayYear
Date
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Non-Invasive Prenatal Paternity (NIPP)/Peekaboo Client Intake Form

Section 1 - Service Selection

Section 2 - Client Information

Section 3 - Pregnancy Eligibility Questions

Section 4 - Participant Information

Section 5 - Collection Preferences

Section 6 - Scheduling Availibility

Section 7 - Acknowledgements