Client Intake Form

Please complete this form before your appointment. Your information is transmitted securely and kept strictly confidential.

Person Ordering the Test

The individual requesting and responsible for this DNA test.

Full name

Test Participants

Participant 3 is optional — complete only if applicable.

Participant 1 name

Participant 1 gender

Participant 2 name

Participant 2 gender

Participant 3 name (if applicable)

Participant 3 gender

Contact Information

Phone number

Address

Appointment Information

Details from your Square booking, if you have them.

Type of test

Appointment date

Appointment time

Medical History

Have you had a blood transfusion or bone marrow transplant in the last 90 days?YesNo

Text Message Consent

Would you like to receive text messages from Precision DNA Services?

Yes, I agree to receive text messages about my appointments, customer care, and occasional promotions.No, I do not want to receive text messages.

Message frequency varies. Message and data rates may apply. Reply STOP to unsubscribe or HELP for assistance. Consent is not a condition of purchase. We do not share your mobile opt-in information with anyone.

Acknowledgment & Signature

I have read and agree to the refund and cancellation policy. I understand deposits are applied to my appointment and that cancellations are subject to the stated policy.

Type your full name

Date

Signature

Draw your signature above