Desired appointment Date and Time (you will be contacted within 24 hrs):

12:30 AM 1:30 AM 2:30 AM 3:30 AM 4:30 AM 5:30 AM 6:30 AM 7:30 AM 8:30 AM 9:30 AM 10:30 AM 11:30 AM 12:30 PM 1:30 PM 2:30 PM 3:30 PM 4:30 PM 5:30 PM 6:30 PM 7:30 PM 8:30 PM 9:30 PM 10:30 PM 11:30 PM

Phone (xxx-xxx-xxxx): *

Full Name of Alleged Father being tested: *

Additional Participant(s):

Types of DNA Testing: *

Select One Avuncular Siblingship Prenatal Amniocentesis Non-Invasive Prenatal Paternity (NIPP)

Purpose of Test: *

LEGAL

INFORMATIONAL

What is the Chain of Custody (COC)?

A COC is a document that must be filled out in order to give us consent to perform the type of DNA test of your choice.

In order to make sure this form/document is filled out correctly upon your scheduled appointment, please provide us with the following information (NOTE: Please do not consume any coffee/tea at least 4 hours prior to scheduled appointment) :

Call Us: 1-800-533-1416 ext. 101