Genex Diagnostics - Premium DNA Testing Services
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Legal Testing Booking Form
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Booking Information
  Alleged Father Mother Child #1 Child #2
First Name
Last Name
Middle Name
Address
City
State / Province
Zip / Postal Code
Country
Phone
Date of Birth (yyyy-mm-dd)
Preferred City for Collection
Note: Please click the check box beside Mother or Child #2 to fill in the required information if applicable.
Result Report Information
Recipient of Result Report Alleged Father Child #1
  Mother Child #2
  Other (Please specify name, relationship, and address below)
 
Payment Information
Credit Card Visa    MasterCard  
Card Number - - -
Expiry Date (mm) / (yy)
CVC Number
Cardholder Name
Note: Please select the method of payment. Credit cards only for online orders. To pay by international money order, call 1-888-262-2263 or download the printable test request form to order by mail.
Additional Information
Court Date yyyy mm dd
Notes
Contact Information
United States - Head Office

(Serving patients in all 50 states)
Genex Diagnostics
#180 - 4616 25th Avenue NE
Seattle, WA 98105
United States
International
Genex Diagnostics
#101 - 1001 W. Broadway, Dept.600
Vancouver BC V6H 4E4
Canada
Toll Free: 1-888-262-2263
Email: staff@genexdiagnostics.com
Internet: http://www.genexdiagnostics.com
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