Paternity DNA Testing Secure Online Order Form

Paternity Test Form Instructions

Please fill out the form entirely. Required fields are noted in bold text.
Choose from one of four testing options.
Test price is located in the "Type of Test" drop down.
After payment is complete, your case manager to confirm your purchase and appointment.
Your information is kept strictly confidential.
*Home Paternity Testing is not permitted in New York State.
If you have questions, please contact a DNA case manager at (877)436-9323.

Step 1
Contact Person
First name :
Last name :
Email Address :
Phone Number :	( ) - x
Address 1 :
Address 2 :
City :
State :
ZIP :
Type of Test :
Other Party
#1 Mother
First Name :
Last Name :
#2 Father
First Name :
Last Name :
#3 Child
First Name :
Last Name :
Add Additional Parties ($195.00/each additional)
Additional Parties :