IMMIGRATION DNA TESTING FORM

(Must be completed prior to your appointment)

PETITIONER INFORMATION
Petitioner Name *
Petitioner Name
What type of relationship have they asked you to prove?
Ethnicity *
Date of Birth *
Date of Birth
Petitioner Gender *
Phone
Phone
BENEFICIARY INFORMATION
Beneficiary Name
Beneficiary Name
Please type the case number on your paperwork
Date of Birth
Date of Birth
Gender
Ethnicity of Beneficiary
Phone
Phone
Where have they indicated we send the results to?