DNA Testing Sign-In Form

Legal & Non-Legal DNA Testing

To ensure the accurate processing of a DNA test, the correct information should be provided to be submitted along with the DNA samples.

Skip to Page 2 for Pet DNA Testing

Testing Location

If testing is done off-site, provide the address of the requested location.

Address

PATIENT INFORMATION

PARTY 1 (Mother)

Who’s getting tested?

Identification

First Name

Middle Initial

Last Name

Date of Birth

Last 4 of Social Security #

Sex

Race

If you are the Mother, answer the following questions.

Have you had a blood transfusion within the past 3 months?

Yes

Have you had a bone marrow/stem transplant before?

Yes

Have you participated in a Parentage DNA Test before?

Yes

ADDITIONAL PARTIES

PARTY 2

Who’s getting tested?

Identification

First Name

Middle Initial

Last Name

Date of Birth

Last 4 of Social Security #

Sex

Race

PARTY 3

Who’s getting tested?

Identification

First Name

Middle Initial

Last Name

Date of Birth

Last 4 of Social Security #

Sex

Race

PARTY 4

Who’s getting tested?

Identification

First Name

Middle Initial

Last Name

Date of Birth

Last 4 of Social Security #

Sex

Race