Register Your DNA Test Kit

Please retain a record of the test barcode and the name of the individual for whom the test is intended before mailing the sample.

Nutrigenomics (NGx) Test Kit

Yes NGx

Pharmacogenomics (PGx)Test Kit

Yes PGx

Who is this test for?

Name of person the test is for

First and last name of person being tested

Email of person being tested

Birth Date

DOB of person being tested

Sex at Birth for the person being tested

Female

Male

Other

Where would you like your results book sent to?

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone number for delivery

Phone

I hereby declare that I have thoroughly read and understood all the terms, conditions, and consent information, and I willingly provide my consent. I confirm that the information I have provided is true, accurate, and complete to the best of my knowledge. If I am ordering on behalf of another individual, I affirm that I have the legal authority and permission to provide consent on their behalf.

Your First and Last name

Your First and Last name (Person registering the kit)

Your Email

Email of the person registering the kit

Signature

Signature field is empty.

Register Your DNA Test Kit

Nutrigenomics (NGx) Test Kit

Pharmacogenomics (PGx)Test Kit

Please note once you click submit, if your form is correctly filled, you will be redirected to our home page.

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