Client Intake Form

Client Intake Form

Please provide your details to help us serve you better.
What is the primary reason you are seeking DNA testing?

Peace of Mind and ClarityLegal or Court-AdmissibleImmigrationNon-Invasive Prenatal PaternityNot Sure
Name of person who ordered the test

First NameLast Name
Male or Female
Name of person being tested (Test Participant 1):

First NameLast Name
Date of Birth (Participant 1)

MonthDayYear
Male or Female
Name of person being tested (Test Participant 2):

First NameLast Name
Date of Birth (Participant 2)

MonthDayYear
Male or Female
Date of Birth (Participant 3)

MonthDayYear
Name of person being tested (Test Participant 3):

First NameLast Name
Male or Female
Email Address*
example@example.com
Your Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Your Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
If you need to add any additional information so we can assist you in finding the correct test, please add it below.
Has any test participant received a blood transfusion or bone marrow transplant within the last 90 days?

YesNo
Please avoid eating, drinking, smoking, or chewing gum for at least 30 minutes prior to sample collection. If you need any assistance please call 203-405-9227.
Signature
Please verify that you are human*
***By proceeding and signing below, you confirm that you have reviewed, understand, and agree to the Terms and Conditions, Privacy Policy, and Cancellation Policy published on our company website. Your completion and submission of this form constitutes your acceptance of these policies.
Should be Empty:

Client Intake Form

Please avoid eating, drinking, smoking, or chewing gum for at least 30 minutes prior to sample collection. If you need any assistance please call 203-405-9227.