Client Intake Screening Form

Who Is Ordering The Test? *

Who Is Being Tested?(part 1) (CHILD'S FIRST AND LAST NAME) *

Sex: *

Male

Female

Non-binary

Date of Birth: * +

Phone Number (Person Ordering Test) *

Location Type: *

Address of Testing Site: *

Who Is Being Tested? (Part 2) (any additional parent/aunt/uncle/sibling/grandparent)

Sex: *

Male

Female

Non- binary

Date of Birth: * +

Email Where Results Will Be Delivered: *

Which tests are you interested in? *

Disclaimer:

Please note that the information provided in this form will be used solely for the purpose of DNA testing services by Labsqueeze backed by DNA Diagnostics Center.

Payments are 100% non-refundable unless the DNA test is cancelled by LBS or cancelled by an official party within 72 hours of the date of the test. Full payment is due the day of the test. A link will be sent. If the payment goes unreceived, a collector will NOT be dispatched out.
Any milegage fees associated with the test is due prior to a collector being dispatched out.
All mileage fees are subject to 62 cents per mile and is calculated for each stop from our headquarters address: 3400 Cottage Way Sacramento,Ca 95825.
Results are sent via email and postal mail within 5 business days of the test being taken.

We are committed to safeguarding 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 guest are allowed during the collection? *

Yes

No

Photo Identification Of Party Ordering Test: *

*

clear