Discovery DNA- Virtual Appointment Request Form

Contact Information

First Name

Last Name

Date of Birth

Phone Number

Email address

Address

City

Province

Postal Code

Appointment Request

Select the service you are requesting:

Genetic Counselling- 30 Minutes Genetic Counselling- 60 Minutes

Preferred Days/ Times:

Appointments are only available Monday-Friday from 9:00am to 3:30pm

Brief description of what you'd like to discuss:

Payment Process Acknowledgement

Discovery DNA requires pre-payment before booking all virtual genetic counselling appointments. Once your form is reviewed, we will send a secure Square payment link by email.

Your appointment will only be scheduled once payment has been completed.

I understand that I will receive a secure Square link to complete payment.

I understand that my appointment will not be scheduled until pre-payment is received.

Privacy & Consent to Contact

Your information is encrypted and securely transmitted through Hushmail. Discovery DNA collects the personal information in this form under the authority of Alberta’s Health Information Act (HIA) for the purpose of reviewing your request, contacting you, processing payment, and scheduling your virtual appointment. We will not share your information without your consent unless required by law.

I consent to Discover DNA contacting me using the information provided.

I confirm that the information I have provided is accurate to the best of my knowledge.

Our team will review your form and send your secure payment link within 1-2 business days.
Once payment is received, we will contact you to schedule your virtual appointment.

Your information will be encrypted.