Tel. 800-USA-LABS
Fax. 214-271-8322
13988 Diplomat Drive, Suite 100
Dallas, TX 75234
FORENSIC CASE SUBMISSION FORM
Please attach completed case submission form to the EXTERIOR of the package containing the samples.
REFERRAL SOURCE
How did you hear about us:
CASE INFORMATION
New Case for Cellmark Forensics
Add’l Submission for Cellmark Forensics Case #
Offense:
Name of Suspect
Name of Victim
Trial Date
AGENCY SHIPPING EVIDENCE
Name
Agency Case Number
Agency
Phone
Address
Fax
City/State/Zip
Email
CLIENT
Same as Agency Shipping Evidence?
Name
Agency Case Number
Agency
Phone
Address
Fax
City/State/Zip
Email
PERSONS TO WHOM LABORATORY REPORTS SHOULD BE MAILED
Name
Name
Agency
Agency
Address
Address
City/State/Zip
City/State/Zip
Phone
Phone
Email
Email
PERSONS AUTHORIZED TO DISCUSS CASE DETAILS
Name
Name
Agency
Agency
Title
Title
Phone
Phone
Yes
No
Same as Client?
Yes
No
Same as Client?
Yes
No
EVIDENCE DISPOSITION
Return Evidence to Agency Shipping Evidence
Name
Return Evidence to Person Indicated to the Right
Agency
Destroy Evidence
Address
Evidence to be picked up at Cellmark Forensics
City/State/Zip
Phone
Email
CASE HISTORY (Please provide a brief case history as it relates to DNA testing and attach any relevant documents)
If you have any questions, please contact customer service at 800-USA-LABS or by email at forensics@labcorp.com
Issuing Authority: The Laboratory Director and/or the Technical Leader(s)
Form-CL-08.08
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Effective Date 11/25/13
EXHIBIT INVENTORY (Please list each item separately. Please photocopy this page for additional exhibits.)
Exhibit No
(as assigned
by shipping
agency)
Description
(include condition and storage history if known)
Permission to
Consume
Sample
(if necessary)
Indicate Type(s) of Testing Required
(Call to discuss testing options if you
need assistance)
SERVICE NOTES
Due to changes in the new FBI Quality Assurance Standards, you must answer the following question before we
are permitted to start your case.
Do you anticipate that any DNA profile from this case will be entered into CODIS or searched in the CODIS database?
Yes
No
Turnaround Time
Normal


5 Business days
10 Business days
15 Business days
20 Business days (for mtDNA only)
See fee schedule for Rush Fees. Rush service cannot be guaranteed without confirmation.
For all forensic relationship testing, please also submit the Relationship Testing form. Call 800-USA-LABS for a copy.
DNA TESTING NEEDS (Please provide information on the objective of the DNA test, specific instructions, and testing priorities.)
CLIENT AUTHORIZATION
I HEREBY AUTHORIZE CELLMARK FORENSICS TO CONDUCT TESTING ON THE SAMPLE(S) LISTED ON THIS FORM
ACCORDING TO THE SPECIFICATIONS LISTED ABOVE.
Name:
Signature:
Date:
Issuing Authority: The Laboratory Director and/or the Technical Leader(s)
Form-CL-08.08
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Effective Date 11/25/13
BILLING/PAYMENT INFORMATION- This section must be completed before testing commences.
CONTRACT CLIENTS
Attached copy of Purchase Order or PO number:
Signed court order attached
Please send invoice to:
Name:
Agency:
Address:
City/State/Zip:
Phone:
Fax:
Email:
PRIVATE OR NON-CONTRACT CLIENTS – Must submit prepayment before testing commences.
Billing Contact:
Name:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Payment is included in the form of a money order, certified check, or corporate check.
Payment by credit card is included (please see separate credit card authorization form).
Issuing Authority: The Laboratory Director and/or the Technical Leader(s)
Form-CL-08.08
3 of 3
Effective Date 11/25/13