DNA Banking Kits Order Form

DNABanking kits are provided as a courtesy. There is no charge when ordering kits.
Kit requests may take up to 1 week for delivery. If your needs are urgent, if you require more than 10 kits, or if you have any other questions, please provide details below in the comments section. You may also contact us by calling (715) 387-0484, ext 0 or email: support@preventiongenetics.com.

If your patient has had a bone marrow transplant or recent blood transfusion, then this kit type may not be recommended. Please contact us for further details.

I am a:

Healthcare Provider

Funeral Home Director

Patient / Consumer

I require mailing labels only

DNA Banking Kit Selection

Select the number of each kit you wish to order.

DNA Banking Brochures

Contact and Shipping Information

Kits are being sent to

Healthcare Provider Patient

* - Denotes a required field. We can accept a P.O. Box address only for one or two kit orders.

PROVIDER CONTACT INFO

First Name: *

Last Name: *

Institution:

E-mail: *

Phone: *

SHIPPING INFO

Patient First Name: *

Patient Last Name: *

Patient Phone Number:

Street Address: *

Address 2:

City: *

State/Province: *

Zip Code: *

Country: *

Comments:

Return Shipping Method

DNA Banking Kits Order Form

DNA Banking Kit Selection

DNA Banking Brochures

Mailing Label Selection

Contact and Shipping Information

Kits are being sent to