To print, click here or select File and then Print from your browser's menu.

SEND THESE PAGES TO HAIRDNA TODAY WITH YOUR SAMPLES
PLEASE PRINT LEGIBLY

PATERNITY TESTING FORM

For guaranteed confidentiality and anonymity, follow the "Confidentiality and Anonymity Instructions" contained in this document.

TERMS AND CONDITIONS

We (HAIRDNA TODAY, hereinafter referred to as DTT CO) and/or its affiliates warrant that the result of the analysis of the biological samples provided to us by you (“the customer”) is correct and accurate according to the findings of the selected Laboratory, and based upon the origin of the samples provided to us. No further representation, warranty or understanding is given or made in relation to the results of analysis.

The information contained in the result of analysis is prepared solely for the use of the customer to whom it is given or sent. Results can only be released verbally to individuals who have knowledge of YOUR SELECTED PASSWORD contained on this form (see below).

We cannot be held responsible in any manner whatsoever, for slow, or delayed results, or for circumstances not under our control. Additionally, we shall not be liable for any loss, or damage suffered by you, or any other person as a result of the provision to you, of the test results, or lack thereof.

In the event of it being necessary for us to require a resubmission of sample(s), it is understood that the first resubmission will most likely, but not necessarily, be performed at no additional charge. All additional resubmissions will be subject to additional charge(s).

Please initial here [__________] to indicate you understand and agree to the above.

We make no representation, expressed or implied, that the result of analysis is fit for any particular purpose. If you intend to use the results of analysis in any court preceding you should email us at contact@hairdnatoday.com so an appointment can be set up in your location for our legal collection services to guarantee that strict chain of custody procedures will be followed.  

You warrant that you are legally entitled to possession of the samples you have provided to us. You agree to indemnify us against any loss or damage that we may suffer as result of you providing us with sample which have not been legally obtained. You should obtain independent legal advise about your legal entitlement to take or obtain in samples of biological material from persons other than yourself.  I will make no representation that I am legally entitled to perform any particular act in order to obtain biological samples for analysis.

Sample(s) that are received without full payment will be held for ten (10) business days to allow for payment to be received by DTT CO. Sample(s) will then be destroyed. DTT CO is not responsible for storing sample(s).

I hereby agree to the terms and conditions set our above and confirm the information I have given is true and correct.

SIGNED: __________________________________________

NAME (please print) __________________________________   Date: ____________________

PASSWORD ________________________________________

 

Sample Identification Table

Date of Collection: _______________

IMPORTANT: Information below should match information provided on Sample ID Slips.

Confidentiality and Anonymity Instructions: Use a false name or simply "Alleged father 1" or "Child 1" when completing the form above and the Sample ID slips. Make note of the false names you use.

Sample ID Slip #

Name

Relationship

Race

DOB

1

______________________

[  ] Alleged father
[  ] Child
[  ] Mother

________________

_________

2

______________________

[  ] Alleged father
[  ] Child
[  ] Mother
________________ __________
3 ______________________
[  ] Alleged father
[  ] Child
[  ] Mother
________________ _________
4 ______________________
[  ] Alleged father
[  ] Child
[  ] Mother
________________ _________
5 ______________________
[  ] Alleged father
[  ] Child
[  ] Mother
________________ __________

 

Notification of Results

Please indicate below how you would like to receive your results.

Confidentiality and Anonymity Instructions: Have your results emailed to a web-based email service such as Yahoo or Hotmail.

I would like to received my results via:

 

[  ] Email at _________________________

 

[  ] Mail at ________________________________________________________(see below)

By providing a mailing address, you are authorizing us to send material to your home and/or office, and as a result, jeopardizing your confidentiality and/or anonymity. Results will be addressed from DDT CO. Please initial here [________] to confirm understanding of this policy.  Please include a self-addressed stamped envelope with your paperwork and samples.

Please note any special instructions for the notification of results:

___________________________________________________________________

___________________________________________________________________

 

Payment Method

Please indicate method of payment below.  All payments must be in US funds. 

Non-US clients please pay via credit card only to avoid testing delays.

In order to receive your results in five business days, payment must be made via money order or credit card. Payments made via personal check may take longer than five business days due to processing.

Confidentiality and Anonymity Instructions: Pay via money order and retain a copy for your records. Do not include a return address on your envelope.

 

Coupon Code ______________


[  ] Money Order

My money order is enclosed.  Please make payable to DTT CO.

 

[  ] Visa or MasterCard

Your credit card will be discreetly billed as DTT CO or its affiliates. A signature of the EXACT name on the card is required.

Card number:

___/___/___/___/  ___/___/___/___/  ___/___/___/___/  ___/___/___/___/

Expiration Date: ___/___/

Card Verification Value Code (CVV): _____ (What is this?)

EXACT name on card:

_____________________________________________________________

EXACT address on statement:

Street: _______________________________________________________

City / State / Zip: _________________________/ _______/ ____________

I agree to pay the total amount according to Card Issuer Agreement (Merchant Agreement if Credit Voucher)

Signature of EXACT name on card:

_____________________________________________________________
PAYMENT CANNOT BE PROCESSED WITHOUT A SIGNATURE

[  ] PayPal

Choose to pay using your credit card, debit card, or bank account with PayPal by going to http://www.hairdnatoday.com/paypal and completing the transaction.

For confidentiality, PayPal payments submitted to us will be shown as DTT CO in your PayPal account.

Payment sent from (email address): ________________________________

Date of purchase: __________

PayPal Transaction ID:________________________________

 

[  ] Check

My check is enclosed.  Please make payable to DTT CO. Remember to sign your check.

 

Please do not send payment in cash.

 

Copyright © 1996-2005 HairDNA Today, a DNA PLUS company.
All Rights Reserved.

SEND THESE PAGES TO HAIRDNA TODAY WITH YOUR SAMPLES
PLEASE PRINT LEGIBLY

To print, click here or select File and then Print from your browser's menu.

 

END OF PATERNITY TESTING FORM