Menopause Biotype Test Registration

Please complete this information in order to register your DNA test. We cannot process your sample without this information.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Telephone (in case we need to contact you about your DNA sample)

4. Email *This question is required.

5. Swab Barcode Number
Please enter the number listed on the collection device.

*This question is required.

6. Password
Please create a strong password that meets these requirements:

1. Minium of 8 characters.
2. Includes at least one number.
3. Includes one of these special characters: # @ $ ! *

*This question is required.