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Kit Activation

    Consent

    Make sure you submit your consent before your sample is delivered back to your lab.

    Informed consent to human genetic testing

    After completing the genetic analysis, I agree that the (anonymized) sample may be used for research or quality assurance purposes and that any results may be published in scientific journals once anonymized.

    Medical and Nutritional Questionnaire

    Information on your medical history and any medication or issues you may be experiencing is crucial for the evaluation of your samples. The BioArte laboratory will analyze your samples, and our microbial expert will interpret the raw data together with the information you include in this form. This process allows the microbial expert to take into consideration your medical history and your current state when evaluating the results.

    Kindly answer the following questions about your medical history, nutrition, and current state of health.

    Personal data

    Date of Birth:

    Contact information

    Sample information

    Sample type:

    Test type:

    Reason for test

    Please try your best to share all the information you can in order for our experts to be able to take into consideration all the possible scenarios and recommend a proper follow-up.

    Medical history

    1. Type of birth:

    Do you suffer from:

    2. Food intolerances?

    What foods are you intolerant to?

    3a. Food allergies?

    What foods are you allergic to?

    3b. Other allergies?

    (Optional) What other allergies do you have?

    4. Metabolic diseases?

    5. Diabetes?

    6. Autoimmune diseases?

    7. Cardiovascular diseases?

    8. Select as many intestinal disorders that refer to you:

    (Optional) Other intestinal disorders

    9. Select as many urogenital disorders that refer to you:

    (Optional) Other urogenital disorders

    10. Select as many skin disorders that refer to you:

    (Optional) Other skin disorders

    11. Select as many cognitive / neurobehavioural disorders that refer to you:

    (Optional) Other cognitive / neurobehavioural disorders

    12. Recent antibiotic intake?

    13. Recent intake of other medication?

    Select type of medication that you have recently taken:

    (Optional) Other medication

    14. (Optional) Additional medical information

    Nutritional insights

    15. Type of diet:

    (Optional) Other type of diet

    16. Do you practice Intermittent fasting?

    (Optional) Your intermittent fasting routine

    17. Have you recently lost a lot of weight?

    18. Do you have a family history of any relevancy to pathology?

    (Optional) Family pathology

    19. Do you suffer from diarrhea or constipation?

    (Optional) Frequency & consistency

    20. Do you suffer from symptoms such as:

    21. What are your hydration levels?

    22. Indicate the number of hours of sleep you get per night

    23. Select the best option to describe your quality of sleep:

    24. Do you take any food supplements (including probiotics)?

    Kindly list the name of the food supplement/s you are currently taking

    25. (Optional) Additional nutritional information

    Dates of samples

    Each of the 2 tubes has a sticker on them on which the sample collection date must be written. It is best to use a marker to write the date of when each sample was collected. If you have trouble writing the collection date on the tubes, you can take note of the dates and fill out the form below:

    Date of Sample 1

    Date of Sample 2


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