DNA Testing Client Information Form
Please complete the form with your details and preferences to proceed with testing.
Test Type
*
Please Select
Paternity
Maternity
Grandparentage
Immigration
Primary Participant First Name
*
Primary Participant Last Name
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Male
Female
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Number of Additional Participants
*
Alleged Father #1 Name
Where will testing be performed for Alleged Father #1?
Alleged Father #2 Name
Where will testing be performed for Alleged Father #2?
Has the primary participant received a blood transfusion in the past 30 days?
*
Yes
No
Are all parties on cordial terms?
*
Yes
No
Upload Photo ID (Required)
*
Upload a File
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Choose a file
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Additional Acknowledgements
DNA Consent
*
Yes
No
Consent for DNA Testing
I, the undersigned, voluntarily consent to the collection of a DNA specimen and the analysis of that specimen for the purpose of DNA testing. I understand that my specimen will be sent to an accredited laboratory for analysis, and results may be used for personal, legal, or immigration purposes as indicated. I release TestLynx Nationwide and its collectors, agents, and laboratory partners from any claims arising from the testing process, except in cases of gross negligence or willful misconduct.
HIPAA Authorization
*
Yes
No
HIPAA Authorization to Release Test Results and Related Health Information
Signature
*
Consent & Authorization
*
Submit
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