Your Name *

First Name

Last Name

Phone

(###)

###

####

Text Friendly *

Can we text you addresses, appointment times, etc.?

Yes

No

Mother's Name

First Name

Last Name

Mother's Birth Date

MM

DD

YYYY

Has an ultrasound been performed? *

Yes

No

Alleged Father's Name

First Name

Last Name

Alleged Father's Birth Date

MM

DD

YYYY

Details

Details regarding your appointment(s)

Mother & Alleged Father will both show up to the same appointment

Mother & Alleged Father require separate appointments at the same location

Mother & Alleged Father live in different cities/states and will need separate appointments

Add Gender ($100)? *

NOTE: We may not be able to extract gender in some cases. We will refund only the $100 in this circumstance.

Yes

No

Preferred Appointment Date

Preferred Day/Time for your appointment.

MM

DD

YYYY

BLOOD REDRAW *

I understand that there is a chance the mother's blood will need to be recollected if the lab is not able to identify at least 3% fetal DNA.

TURNAROUND TIMES *

I understand turnaround times are an approximation and results can take longer.

REFUNDS *

I understand that all DNA tests offered by Northwest DNA Testing are non-refundable.