Genex Diagnostics - Premium DNA Testing Services
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Court Admissible DNA Maternity Testing Order Form
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Shipping Information for DNA Test Kit
First Name
Last Name
Middle Name
Address
City
State / Province
Zip / Postal Code
Country
Phone
E-mail
Note: E-mail and Phone are required if you would like the test kit to be shipped by Express delivery.
Select a Test Type
1 Mother, 1 Child (Results in 3 to 5 working days) $230 US  
1 Mother, 2 Children (Results in 3 to 5 working days) $315 US  
1 Mother, 1 Child (Results in 2 to 3 working days) $305 US EXPRESS SERVICE
1 Mother, 2 Children (Results in 2 to 3 working days) $465 US EXPRESS SERVICE
Plus Shipping and Handling Fee (choose one)
Regular Delivery (Receive your kit in approximately 5 working days) $0 US
Express Delivery (Receive your kit within 48 hours - Canada & US only) $20 US
Shipping Information for Genex Result Report (check all that apply)
 By E-mail
  Use the same E-mail address above
  E-mail
 By Mail
  Use the same shipping address above
  Address
  City
  State / Province
  Zip / Postal Code
  Country
Payment Information
Credit Card Type 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.
Create a Passowrd
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Note: To gain access to your test results by phone, you will be asked to provide a password you created here. Minimum 4 characters.
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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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