Form cover
Page 1 of 1

TAF Diagnostic Services DNA Client Intake Form

Welcome to TAF Diagnostics Services! Our intake form is designed to gather essential information for your DNA testing process. Please provide accurate details to ensure seamless and accurate results. Your privacy and confidentiality are our top priorities. Thank you for choosing TDS for your genetic testing needs!

Today's Date

What time would you like to visit?

Who is ordering the test?

Who is being tested? (child's name)

Child's Gender

Child's Race

Child's Date of Birth

Who is being tested? (any additional parent/​aunt/​sibling/​grandparent)

Gender

Race

Date of Birth

How are you related to the child?

Have you had a blood transfusion in the last 30 days?

Have you had a blood transfusion in the last 30 days?

Have you had a bone marrow or stem cell transplant?

Have you had a bone marrow or stem cell transplant?

Phone number

Email Where Results Will Be Delivered