• Mecca Medical DNA Testing Intake Form

  • Thank you for choosing Mecca Medical & DNA Testing Solutions.

    This intake form collects the information required to establish and coordinate your DNA testing case with our laboratory partner and, when applicable, professional collection partners.

    Please provide complete and accurate information for every person who will participate in the DNA test. The information requested will vary based on the type of testing selected.

    For legal DNA testing, identity verification, professional specimen collection, and chain-of-custody documentation are required.

    For EZPZ™ Home DNA Test Kits, specimens are self-collected according to the instructions provided with your kit and are intended for informational, peace-of-mind purposes unless otherwise stated.

    Important: If you scheduled through Calendly for a legal DNA testing service, the time selected is for order processing only. It is not your specimen-collection appointment. Team Mecca Medical will coordinate collection arrangements after your intake information has been reviewed.

    Please do not submit Social Security numbers, medical records, or other information that is not specifically requested on this form.

  • DNA Testing Service

  • What type of DNA test are you requesting?*
  • Purchase Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred method of communication*

  • Relationship DNA Testing Information

  • What type of relationship DNA testing are you requesting?*

  • Grandparentage Testing Information

    Please answer the questions below about the biological relationships involved in this test. This information helps Team Mecca Medical establish the appropriate grandparentage case and coordinate testing with the laboratory.
  • Is that biological parent participating?*
  • Are multiple children being tested against the same grandparent?*
  • If yes, do the children share the same connecting biological parent?*
  • Will all participants complete specimen collection in the same city or geographic area?*
  • How many people will participate in this DNA test?*
  • Will any participant be under 18 years old?*

  • Participant 1 Information

    Please enter the name exactly as it appears on the participant's identification or legal documents.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant's Role in This DNA Test*

  • Participant 2 Information

    Please enter the name exactly as it appears on the participant's identification or legal documents.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant's Role in This DNA Test*

  • Participant 3 Information

    Please enter the name exactly as it appears on the participant's identification or legal documents.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant's Role in This DNA Test*

  • Participant 4 Information

    Please enter the name exactly as it appears on the participant's identification or legal documents.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant's Role in This DNA Test*

  • Participant 5 Information

    Please enter the name exactly as it appears on the participant's identification or legal documents.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Participant's Role in This DNA Test*

  • Minor Child Authorization

    Please provide the information below to confirm that the person authorizing testing has the legal authority to consent on behalf of the minor child or children participating in the DNA test.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Final Review & Acknowledgments

    Please review and authorize Team Mecca Medical to use the information provided in this form to establish and coordinate your DNA testing case.

  • Case Establishment Authorization

    Please review and authorize Team Mecca Medical to use the information provided in this form to establish and coordinate your legal DNA testing case.

  • Payment Authorization & Identity Verification

    To help verify the identity of the person authorizing payment and case processing, please provide the information below.
  • Is the person submitting payment the same person completing this intake form?*
  • Format: (000) 000-0000.
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  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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