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1-800-463-4310

Paternity (DNA) Collection Form

Donor 1 Information

Name:

Phone Number:

File Number:

Mother Child Alleged Father

Other:

Address of Collection

Street:

Postal Code:

City:

Entry:

Donor Availability

Donor 2 Information

Name:

Phone Number:

File Number:

Mother Child Alleged Father

Other:

Address of Collection

Street:

Postal Code:

City:

Entry:

Donor Availability

Donor 3 Information

Name:

Phone Number:

File Number:

Mother Child Alleged Father

Other:

Address of Collection

Street:

Postal Code:

City:

Entry:

Donor Availability

Supervisor Information

Name: Email:

Phone Number: Fax Number:

Caseworker Information

Name: Email:

Phone Number: Fax Number:

Results

Sent To: Fax Mail Number of Copies:

Phone: Fax: Email:

Additional Comments

Please confirm that you have received supervisor authorization for this test.