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Completing the DNA test request form accurately is essential for effective processing and analysis. This guide provides step-by-step instructions to ensure all required information is filled out properly, facilitating a smooth experience for users.

Follow the steps to complete your DNA test request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the patient information section, provide your last name, first name, middle initial, street address, city, state, zip code, and preferred contact phone number. Please print clearly to ensure accurate processing.
3. Enter your date of birth and select your gender from the provided options.
4. Indicate your race/ethnic identification by checking the appropriate box that applies to you.
5. Complete the patient insurance information section. Provide the name of your primary insurance carrier along with policy/ID and group numbers. If applicable, attach copies of your insurance cards.
6. Choose a billing option from the list and provide the necessary details. If using a credit card, ensure to attach a photocopy.
7. Mark any applicable medical necessity options in the patient medical information section and attach any relevant documents, such as a photocopy of your medication sheet.
8. In the panel options section, select all applicable panels and individual options that pertain to your test.
9. Fill out your practice/clinic information, including the practice/clinic name, address, physician's name, and phone number.
10. Provide your physician's authorization, including ICD-9 codes if applicable, and ensure the physician signs and dates the form.
11. Review all the information provided to ensure its accuracy. When satisfied, save any changes you made, then download, print, or share the completed form as needed.

Start completing your DNA test request form online now for efficient processing!