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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:

    Medical history

    1. Type of birth:

    Do you suffer from:

    2. Food intolerances?
    3. Allergies?
    (Optional) What are you allergic to?

    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?
    14. Select type of medication that you have recently taken:

    (Optional) Other medication

    15. (Optional) Additional medical information

    Nutritional insights

    16. Type of diet:

    (Optional) Other type of diet

    17. Do you practice Intermittent fasting?

    (Optional) Your intermittent fasting routine

    18. Have you recently lost a lot of weight?

    19. (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