DNA Testing Client Information Form
Please complete all required fields to begin your DNA testing process.
Test Type
*
Please Select
Paternity
Maternity
Grandparentage
Immigration
Primary Participant First Name
*
Primary Participant Last Name
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
# of Additional Participants
*
Alleged Father #1
*
Alleged Father #2
*
Where will testing be performed for AF #1
*
Where will testing be performed for AF #2
*
Have you had a blood transfusion in the past 30 days?
*
Yes
No
Are all parties on cordial terms?
*
Yes
No
Photo identification (Primary Participant)
*
Upload a File
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Additional Acknowledgements
Do you understand that the total costs of the tests will be billed today?
Yes
No
Do you understand that approximate mileage of supplied addresses will be due the day before your scheduled test (62 cents per mile)?
Yes
No
Do you understand the 48-hour cancellation and refund policy?
Yes
No
Do you understand that results are sent to the person who purchases the test?
Yes
No
Payment for DNA Testing Service
Choose your service and complete payment by credit or debit card.
Service Selection
*
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DNA Testing Service
Credit/debit card payment for DNA testing service
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