X or Y Early Gender Test Online Consent Form
Please verify that the information below is correct, then click the "Continue" button below.
Case Number:
Tester First Name:
Tester Last Name:
Tester Email:
Alternate Email For Result:
Phone:
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 no males present.
