EXPRESS CONSENT FOR DNA ANALYSIS Sneak Peek Ultrasound.

EXPRESS CONSENT FOR DNA ANALYSIS Sneak Peek Ultrasound.
1. DNA Analysis Notice

I have had an opportunity to discuss the plan DNA analysis with the provider collecting my sample. All my questions have been answered to my satisfaction.

2. Express Consent for DNA Analysis

I give Sneak Peek Ultrasound (AKA The Womb, LLC), the provider collecting the sample, and the laboratory processing the sample express consent to:

Take a blood sample and send the sample to a laboratory for DNA analysis. I request the laboratory to send the test results to myself as well as Sneak Peak Ultrasound.
Process, collect, result and store said DNA sample according to the Terms and Conditions stated in the separate laboratory consent form.

3. Risk Disclaimer

I understand the risk and limitations of a DNA analysis as explained by my provider collecting my sample.

4. Competency

The individual signing this form is mentally competent to provide this express consent on their behalf.
On this date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Signature of patient
Name of patient

First NameLast Name
Email (where we'll send your copy of this consent)
example@example.com
Should be Empty: