Name
Email
ADDRESS
Phone
Is this for a Non-Invasive Prenatal Test or Gender Reveal?
If this is for Immigration, do you have a legal case pending?
Are there any domestic issues between the testing parties, where they can't be in the same room?
SELECT TEST AND PAY DEPOSIT or Pay in Full
SELECT TEST AND PAY DEPOSIT or Pay in Full
Paternity
Immigration
Forensics
Party 1 Information
Who is being tested.
Race
Race
White
Black/African American
Asian
Party 1 ADDRESS
Party 1 Date of Birth
Party1 Phone
Party 2 Information
Who is being tested.
Race
Race
White
Black/African American
Asian
Party 2 ADDRESS
Party 2 Date of Birth
Party2 Phone
Party 3 Information (Child)
child's name
Race
Race
White
Black/African American
Asian
Are there any domestic issues between the testing parties, where they can't be in the same room? for safety purposes only
Have you had a blood transfusion in the last 30 days?
Do you have any pets?
Have you had a bone marrow or stem cell transplant?
Please note that the information provided on this form will be used solely for the purpose of DNA testing services by DNA Concierge Plus backed by an AABB credentialed Laboratory. 1. The initial $75 deposit is 100% non-refundable unless canceled by DCP or an official party within 72 hours before the date of the test. Full payment is due he day of the test. A payment link will be sent 24 hours before the test or pay through this website. If the payment is not received within 4 hours of testing, a collector will not be dispatched out. 2. ALL additional mileage fees associated with the test are due prior to a collector being dispatched out. 50 miles roundtrip are included and calculated from our headquarters address 1440 W Taylor Street, Chicago, IL 60607. 3. ALL additional mileage fees are subject to $0.62 per mile after 50 miles roundtrip. 4. ALL parties will need Photo ID (Driver's License, State ID, or Passport) 5. ALL parties will have pictures taken and sent with the DNA tests to the Lab for ID purposes only. 6. Results will be sent via email to the ordering party only and postal mail if request within 5 business days of the test. 7. NO additional guest or pets are allowed during testing. Testing usually only takes 15-30 minutes. 8. NO food or drink 30 minutes before the test. DNA Concierge Plus are committed to safeguarding your privacy and will not share your personal information without your consent, except as required by law.
Do you understand that NO additional guests or pets are allowed during testing?
Photo ID of Party ordering test? (front and back both)
Signature- type in signature
By signing this application, you authorize DNA Concierge Plus to charge your provided payment method for any and all DNA testing services, including but not limited to service balances and mileage fees, on the day of service.
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