Peekaboo^™ Kit Registration

Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Email*

Enter Email Confirm Email

Phone*

ZIP*

(i.e. XXXXX)

We cannot accept samples from New York state*

I understand that Peekaboo samples collected and mailed from New York state cannot be processed per NY state regulations. We will reject packages with New York state tracking information. All customers, including NY state residents, must collect and mail samples from another state.

Product ID (located on Sample Tube)*

Date of sample collection*

MM slash DD slash YYYY

This test has not been validated prior to 6 weeks of pregnancy and we cannot guarantee accuracy of results if samples are submitted early. Please do not submit tests prior to 6 weeks of pregnancy.

I confirm that I was at least 6 weeks pregnant at time of sample collection*

Yes

First date of last menstrual cycle*

MM slash DD slash YYYY

Estimated due date*

MM slash DD slash YYYY

Comments

This field is for validation purposes and should be left unchanged.

*Over 99% accuracy validated in a clinical study of 215 pregnant women between 7 and 39 weeks gestation with blood drawn from venipuncture.

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Peekaboo^™ Kit Registration