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Who is ordering the test?

First NameLast Name
Who is being tested? (Party 1) (CHILD'S FIRST AND LAST NAME)

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Sex
Who is being tested? (Party 2) (any additional parent/aunt/sibling/grandparent)

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Sex
Who is being tested? (Party 3) (any additional parent/aunt/sibling/grandparent)

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Sex
Phone Number (Person ordering the test)
Format: (000) 000-0000.
Additional Phone Party
Please enter a valid phone number.Format: (000) 000-0000.
Address of Testing Party 1:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location Type
Residential, Commercial, or Public Place
Address of Testing Party 2: (only complete if we need to travel to this address to test)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location Type
Residential, Commercial, or Public Place
Email Where Results Will Be Delivered:
Is there a lingering domestic issues where parties cannot be in the same room?
Disclaimer
The information provided through this form will be used to coordinate the DNA specimen collection and testing services requested from Precision DNA. When applicable, information and specimens may be provided to an independent laboratory selected for the requested testing service.

Please note that the deposit paid today is non-refundable, except if the DNA test is canceled by Precision DNA or by an official party within 72 hours of the test date. The full payment is required on the day of the test. A payment link will be sent; if payment is not received, a collector will not be dispatched.

Test results will be sent via email and postal mail within 5 business days of the test.

We are committed to protecting your privacy and will not share your personal information without your consent, except as required by law.

By completing and submitting this form, you acknowledge and agree to these terms.
Do you understand that no additional guests are allowed during the collection?
Photo Identification of Party Ordering Test:

Cancelof
Blood Transfusion
Has anyone had a blood transfusion in the last 90 days?
Signature of person ordering test:

DNA Test Deposit

$75.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Precision DNA Client Intake Form

Welcome to Precision DNA! Our intake form collects the necessary information to ensure a smooth and accurate DNA testing process. Please provide precise details to guarantee the best results. Your privacy and confidentiality are our utmost priorities. Thank you for choosing Precision DNA for your genetic testing needs!
Should be Empty:

Disclaimer

Blood Transfusion

DNA Test Deposit*

Precision DNA Client Intake Form

DNA Test Deposit