DNA Testing Intake Form

Welcome to Vital Genetics Mobile DNA Testing. Our intake form is designed to gather essential information for your DNA testing process. Please provide accurate details to ensure seamless and precise results. Feel free to book your appointment once you are ready to move forward.

Thank you for choosing us for your genetic testing needs.

First Name

Last Name

Who is Being Tested? (Party 1)(Child's first and last name)

Sex

Date of Birth

Who is being tested? (Party 2)(Any additional parent/aunt/sibling/grandparent)

Sex

Date of Birth

Who is Being Tested? (Party 3)(Any additional parent/aunt/sibling/grandparent)

Sex

Date of Birth

Phone (Person ordering test)

Additional Party Phone

Address of Testing Party 1

Location Type

Email Where Results Will Be Delivered

Is this a prenatal test?

Yes

Is there a lingering domestic issue where parties cannot be in the same room?

Yes

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

The deposit today is 100% non-refundable unless the DNA test is canceled by EMD or canceled 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 mileage fees associate with the test is due prior to a collector being dispatched out.
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.

No additional guests are allowed during the collection.

Signature of person ordering the test

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

We are dedicated to providing accessible and reliable mobile DNA testing services.

Learn More

DNA Testing Intake Form

Contact Us