Collect my DNA Kit
061 547 0502 | www.ellagenetics.com | info@ellagenetics.com
Client details
Please fill in the form based on the client who took the saliva collection sample
Name
*
First Name
Last Name
Please type the barcode on the DNA kit
*
The barcode number will start with [5600211020] on your tube
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Collection
The Courier guy will relocate directly back to us, please indicate any notes on delivery times and instructions below.
1. Arrange collection from same address as the delivery address
*
Please Select
1. Yes
2. Please collect from the different address below
2. Please collect from another address below
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Notes to Courier Collection
Terms and Conditions
Please note you hereby give Ella Genetics permission to run the lab services and will be liable for the payment of your DNA test package.
I hereby permit Ella Genetics (PTY) Ltd to test my DNA.
https://www.ellagenetics.com/privacy-policy/
Submit
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