Prenatal Paternity Test Registration

For Self-Collection

Please use this form to register your Prenatal Paternity Test if you plan to obtain blood collection from your own provider trained in venipuncture collection (phlebotomist, physician, etc).

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Contact Name*
This name will NOT appear on the test results for confidentiality reasons. This will only be used for order and sample tracking purposes.
7-digit code ending in "-1-PAT" on your instructions card.
Would you like the baby's gender to be on the report? (No extra fee)*
Passwords are case-sensitive.

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