PLEASE COMPLETE THE FOLLOWING SECTION AND RETURN TO THE CONSULATE ON MONDAY, TUESDAY, THURSDAY OR FRIDAY AT 12 NOON:
Beneficiary Name (Last, First,Middle):
_________________________________________________________________________________
Passport Number:
__________________________________________________________________
DO NOT WRITE BELOW THIS LINE
I have read and understand the contents of this information sheet. I choose to proceed with genetic testing in an effort to prove the relationship claimed in the immigrant visa petition filed on my behalf.
I understand that a negative outcome will result in the immediate return of this petition to the INS, and I may be found ineligible for any future U.S. visas.
I understand that all pending investigations will be suspended while the genetic test is carried out.
______________________________________________Beneficiary's Signature
Signed and sworn before me on (Date) ______________________at Lagos, Nigeria
Consular Officer _______________________________________
ALABAMA:
University of Alabama at Birmingham
Immunogenetics/DNA Diagnostic Laboratory
223 Professional Arts Building
1025 18th Street South
Birmingham, AL 35294-4440
Tel: (800) 499-4363
Tel: (205) 934-7107
Fax: (205) 934-4062
ARIZONA:
Blood Systems, Inc.
6220 East Oak Street
Scottsdale, AZ 85267
(602) 946-4231
CALIFORNIA:
Long Beach Genetics
2384 East Pacifica Place
Rancho Dominguez, CA 90220
Tel: (800) 824-2699
Tel: (310) 632-8900
Fax: (310) 632-9424
Children's Hospital and Health Center
Genetic Services
3020 Children's Way
San Diego, CA 92123
(619) 495-4911
Genetic Profiles Corp.
6122 Nancy Ridge Drive, #205
San Diego, CA 92121
Tel: (800) 551-7763
Tel: (619) 623-0840
Fax: (619) 623-0842
COLORADO:
Analytical Genetic Testing Center, INC.
7808 Cherry Creek South Dr. #2
Denver, CO 80231
(303) 750-2023
The Laboratories at Bonfils
Parentage Testing Laboratory
717 Yosemite Circle, 2nd Floor
Denver, CO 80230
Tel: (303) 365-9000
Fax: (303) 343-6666
CONNECTICUT:
Lifecodes Corporation
550 West Avenue
Stamford, CT 06902
(203) 328-9504
HAWAII:
St. Francis Medical Center
Parentage Testing
2230 Liliha Street
Honolulu, HI 96817
(808) 547-6536
LOUISIANA:
ReliaGene Technologies, Inc.
5525 Mounes Street, Suite 101
New Orleans, LA 70123
(504) 734-9700
FAX: (504) 734-9787
MASSACHUSETTS:
University of Massachusetts Medical Center
Tissue Typing Laboratory
55 Lake Avenue, North
Worcester, MA 01655
(508) 856-2428
CBR Laboratories, INC.
Parentage Testing
800 Huntington Avenue
Boston, MA 02115-6399
(617) 731-6470
MARYLAND:
Baltimore RH Typing Laboratory Inc.
400 West Franklin Street
Baltimore, MD 21201
(401) 225-9595
MAINE:
Maine Medical Center Research Institute
Immunogentics Laboratory
125 John Roberts Road
Suite 8
South Portland, ME 04106
(207) 761-9090
MICHIGAN:
Lifecodes Corporation
East Lansing Division
Parentage Testing
2947 Eyde Parkway
Suite 110
East Lansing, MI 48823
Tel: (517) 349-3890
Fax: (517) 349-6879
National Legal Laboratories, Inc.
Parentage Testing
2947 Eyde Parkway
Suite 110
East Lansing, MI 48823
Tel: (800) 837-1504
Fax: (517) 349-6879
Sparrow Hospital
Paternity Laboratory
1215 E. Michigan Ave.
Lansing, MI 48909-7980
(517) 483-2515
MINNESOTA:
Memorial Blood Centers of Minnesota
Paternity Testing Laboratory
2304 Park Avenue S.
Minneapolis, MN 55404-3789
Tel: (800) 982-9134
Tel: (612) 871-3300
Fax: (612) 872-3689
MISSISSIPPI:
Scales Biological Laboratory, INC.
220 Woodgate Drive, S.
Brandon, MS 39042 (601) 825-3211
MISSOURI:
Cross Clinical Laboratories
527 W. 39th Street
Kansas City, MO 64111
Tel: (816) 960-1930
Fax: (816) 960-0755
NORTH CAROLINA:
Laboratory Corporation of America Holdings
(Formerly Roche Labs)
1440 York Court Extension
Burlington, NC 27215
Tel: (800) 334-5161, ext. 7333
Tel: (336) 584-5171; ext. 7333
Fax: (336) 538-2263
Duke University Medical Center
Transfusion Services
Box 2928
Durham, NC 27710
(919) 684-3089
NEW JERSEY:
Clinical Testing and Research, INC.
20 Wilsey Square
Ridgewood, NJ 07450
Tel: (201) 652-2088
Fax: (201) 652-2775
NEW MEXICO:
New Immunogenetic Laboratory
Room BRF 227
915 Camino De Salud NE
Albuquerque, NM 87131
(505) 841-1313
NEW YORK:
Suny Health Science Center at Syracuse
Parentage Testing Laboratory
750 E. Adams Street
Syracuse, NY 13210
OHIO:
Medical College of Ohio
Department of Pathology
DNA Profiling Laboratory
3000 Arlington Avenue
P.O. Box 10008
Toledo, OH 43699
Tel: (419) 383-5256
Fax: (419) 383-3066
DNA Diganostics Center
205 Corporate Court
Fairfield, OH 45014
Tel: (513) 881-7800
Fax: (513) 881-7803
Genescreen
5698 Springboro Pike
Dayton, OH 45449
(513) 294-0973
Genetica DNA Laboratories Inc.
8740 Montgomery Road
Cincinnati, OH 45236
Tel: (800) 433-6848
Fax: (513) 985-9983
OKLAHOMA:
H. A. Chapman Institute of Medical Genetics
Children's Medical Center
5300 E. Skelly Drive
Tulsa, OK 74135
(918) 628-6363
OREGON:
A.R.C. Blood Service Pacific-N.W. Region
P.O. Box 3200
3131 North Vancouver Avenue
Portland, OR 97208
(503) 280-1449
SOUTH DAKOTA:
Biogenetic Services, INC.
2308 6th Street E.
Brookings, SD 57006
(605) 697-8500
TENNESSEE:
Gene Proof Technologies
187 Graylynn Drive
Nashville, TN 37214
Tel: (800) 844-7851
Tel: (615) 889-0444
Fax: (615) 889-5982
Micro Diagnostics, Inc.
Air Park Center III
1400Donelson Pike
Suite A-15
Nashville, TN 37217
Tel: (615) 360-5000
Tel: (888) 256-6383
Fax: (615) 360-5003
E-Mail: www.microdx.dom
TEXAS:
Identigene
7400 Fannin
Suite 1250
Houston, TX 77054
Tel: 800-362-8973
Fax: (713) 798-9515
University of North Texas Health Science Center at Fort Worth
DNA Identity Laboratory
3500 Camp Bowie Blvd.
Forth Worth, TX 76107
(817) 735-5014
Genescreen
2600 Stemmons Freeway
Suite 133
Dallas, TX 75207
(214) 631-8152
UTAH:
DNA Diagnostic Laboratory
University of Utah
Eccles Genetic Institute
10 North 2030 East
Room 7400
Salt Lake City, UT 84112
(801) 581-8334)
VIRGINIA:
Fairfax Identity Laboratories
Genetics and IVF Institute
3025 Hamaker Court
Suite 203
Fairfax, VA 22031
Tel: (800) 848-DNA
Tel: (703) 698-3919
WASHINGTON:
Genelex Corporation
2203 Airport Way South
Suite 350
Seattle, WA 98134
(206) 382-9591
WISCONSIN:
The Blood Center of South East Wisconsin, Inc.
Parentage Testing Laboratory
1701 W. Wisconsin Avenue
Milwaukee, WI 53233
(414) 937-6198
American Red Cross Badger Region
4860 Sheboygan Avenue
P. O. Box 5905
Madison, WI 53705-0905
(608) 233-9300