DNA Banking and Clinical Testing Kits Order Form

PreventionGenetics offers saliva kits that can be shipped directly to patients' homes. We will ship kits to US, Canada & internationally barring any restrictions.

DNA Banking and Clinical Testing kits are provided as a courtesy. There is no charge when ordering kits. Kits sent within the U.S. and Canada will include pre-paid return postage. Kits sent internationally will not include pre-paid return postage. DNA Banking does not cover overnight shipping.

Kits are being sent to

Healthcare Provider Patient

Full Kits or Mailing Labels Only?

Kits Labels Only

Kit Selection

Please select the number of each kit you wish to order:

Clinical Testing

DNA Banking

DNA Banking Brochures

Do you wish to order DNA Banking Brochures?

DNA Banking

Fetal Concerns

Please review our specimen types to confirm acceptable specimens for testing desired.

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.

Shipping and Contact Information

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

PROVIDER 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