Order your Paternity Testing from Genetic Profiles' DNA testing Laboratory using a printable, mailable order form

Mother's Name:

___________________________________________

DOB:

___________________________________________

Address:

___________________________________________

City, State, Zip Code:

___________________________________________

Phone (home, work):

___________________________________________

Can we leave a message regarding appointment information?

Yes__

No__

Race:

Caucasian__

Black__

Hispanic__

Asian__

Native American__

Other__

Child's Name:

___________________________________________

DOB:

___________________________________________

Address:

___________________________________________

City, State, Zip Code:

___________________________________________

Phone (home, work):

___________________________________________

Can we leave a message regarding appointment information?

Yes__

No__

Alleged Father's Name:

___________________________________________

DOB:

___________________________________________

Address:

___________________________________________

City, State, Zip Code:

___________________________________________

Phone (home, work):

___________________________________________

Can we leave a message regarding appointment information?

Yes__

No__

Race:

Caucasian__

Black__

Hispanic__

Asian__

Native American__

Other__

*Additional Tested Person:

___________________________________________

Relationship:

___________________________________________

DOB:

___________________________________________

Address:

___________________________________________

City, State, Zip Code:

___________________________________________

Phone (home, work):

___________________________________________

Can we leave a message regarding appointment information?

Yes__

No__

Race:

Caucasian__

Black__

Hispanic__

Asian__

Native American__

Other__

*note - extra fee(s) will apply for additional tested person(s). Please call 1-800-551-7763 for details

Appointment:

( )Together

( )Separate

Preferred appointment day/time:

__________________________

Specimen type:

Blood___

Buccal___

Contact Person: _____________________________

Phone (include area code): _______________________

Is there a representative or attorney involved?

For mother and/or child:

For alleged father:

Yes__

No__

Name of representative:

Name of representative

_________________________________

Payment

Full payment or a deposit of $100 is required to initiate the DNA testing process. We accept MasterCard, Visa, Discover, American Express and payment by Money Order. Please do not mail cash. The $100 deposit is non- refundable after the process has been initiated. The collection facility in your area will charge a fee ranging from approximately $15 to $45 per person to collect specimens. Once we have received this form along with your payment, our scheduling department will begin to coordinate an appointment in your area. You will receive a call from our scheduling department with your DNA test appointment information.

( ) Standard
6-10 Working Day Service - $420

( ) FAST PROFILE
5 Working Day Service - $500

( ) ULTRA FAST PROFILE
3 Working Day Service - $700

Full Payment $ ____________________

Deposit $ ____________________

( ) Master Card

( ) Visa

( ) Discover

( ) American Express

Card No: ___________________________________

Expiration Date: _______________

Exact Name on Card: _____________________________ Cardholder's Signature: _____________________________

Mail to: Genetic Profiles, 10675 Treena St., Suite 103, San Diego, CA 92131

Fax to: (858) 348-0048

Genetic Profiles - Mail In Paternity Test Order Form Please print this form using the print button on your web browser. Fill out form completely, especially including the telephone number(s).

Genetic Profiles - Mail In Paternity Test Order Form
Please print this form using the print button on your web browser.
Fill out form completely, especially including the telephone number(s).