X or Y Consent – Confirm Information

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:

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.

If all the information above is correct, continue to Consent Form Sign Page by clicking the button below. Note that the name of the individual collecting their fingerprick sample MUST be used on this form--using a different name will void our moneyback guarantee.

(Something is not right, take me back!)