X or Y – Males Present Waiver Confirmation

X or Y Early Gender Test Electronic Consent Form

Please verify that the information below is correct, then click the button at the bottom of the page to continue.

Case Number:

First Name:
Last Name:

First Day Of Last Menstrual Period:
Eligibility Date:
Sample Collection Date:
Baby's Estimated Due Date:

Fingerprick sample was taken in a clean environment with males present.

If all the information above is correct, continue to Waiver Signature Page by clicking the button below.

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