Questionnaire

Kindly provide the order number* of the purchased kit
*Your order number can be found on the confirmation email you received when purchasing your kit.

Kindly tick the option that refers to you:
I am… the person submitting the samplea relative or guardian of the person submitting the samplea professional filling in this form on behalf of my client

Consent to Personal Data (Mandatory)

i. I have been fully informed about the oral microbiome test (and any additional related test), including its purpose, procedure, limitations, costs, and the implications of the results.
ii. I acknowledge that the test results are not a substitute for a medical diagnosis and that The BioArte does not take responsibility for the use of the results by me or my clinician and any consequences thereof.
iii. I confirm that the personal and medical information I have provided is accurate and truthful. I understand that the clinical team may contact me for additional information, which may be used for result interpretation purposes. I agree that the test report may be forwarded to my clinician for appropriate advice.
iv. I agree to provide a biological sample and consent to its shipping to The BioArte facilities for testing and analysis.
v. I consent to the collection, storage, and processing of my personal data, including health-related information. I understand that my data will be used solely for the purposes of conducting the oral microbiome test and providing me with the results. I am aware that my identifiable data will not be shared with third parties without my explicit consent, except as required by law.
vi. I consent to receiving the test report via email to the address provided in the below contact information.

I accept

Consent for Research Purposes (Optional)

The aim of our research is to explore the role of the oral microbiota in human’s health and/or its impact on medical treatments.
The oral microbiome plays an important role in overall health. Imbalances have been linked to conditions such as infections and inflammation. We are interested in understanding how differences in the oral microbiome may influence health outcomes.
To investigate this, we will analyse oral microbiota samples from participants. Your participation involves providing an oral swab sample, which will be analysed for this purpose.
The insights gained from this study could be crucial in improving our understanding of the oral microbiome and developing better, more personalized medical treatments in the future.
Your involvement is entirely voluntary, and you can withdraw at any time without affecting your current or future medical care. We assure you that all the data collected will be kept confidential and used solely for research purposes.
By signing this consent form, you agree to provide an oral sample for our study and acknowledge that you have been informed about the study's purpose, procedures, and your rights as a participant.
Thank you for your cooperation and contribution to this important research.

I acknowledge that my Personal (Health) Data and remaining sample could contribute to further research, development, and enhancement of diagnostic techniques and potential therapeutic remedies. I consent to The BioArte's storage, once pseudonymized, of:

• My Personal (Health) Data and analytical results.

• Both original and processed sample

and that it will be kept by The BioArte for a minimum period of 10 years.

The company will use this data, along with the remaining samples that have been pseudonymized, for scientific research (both internally and externally) as well as for commercial research in the field related to the human microbiome. The aim is to gain a better understanding of the microbiome's role in an individual's overall health and susceptibility to diseases, as well as their potential response to treatments. Consent can be revoked at any time as explained below.
Public and private healthcare institutions, bio-medical companies worldwide, can be granted access to the patient’s pseudonymized data for research purposes, with the relevant guarantees adopted to ensure legitimacy of the data transfer (especially if the recipient is in a non-EEA country).
Please visit www.thebioarte.com or contact [email protected] for updated information on the research projects in which your pseudonymized data may be used.

Please visit Data Privacy to consult our data privacy policy.

HAVING READ AND UNDERSTOOD THE INFORMATION ABOVE, I CONFIRM THAT:
i. I have read and understood the indication, purpose, characteristics, scope, procedure, success rate, complications, limitations, and economic cost of this test, and have had the opportunity to ask questions and any questions that I had were answered fully and to my satisfaction. I have also been given information on the implications of the test results, any possible follow-up, and where applicable, any further tests that might be required. I am aware that clinical and technical staff will be at my disposal for any questions or additional counseling that I may require once the results of the test are known.
ii. I understand that the results of this test are not a substitute for a medical diagnosis performed in a clinical setting provided by a healthcare professional. I accept that The BioArte does not take responsibility for the use, by me or my clinician, of the results obtained and any consequences of such use.
iii. I confirm that the information I have given, both personal and medical, is accurate and truthful. I acknowledge that the clinical team may reach out to me for additional clinical information, which may include details required for research purposes.
iv. In view of the complexity of the tests, results should be assessed alongside other clinical information by healthcare professionals. Consequently, I agree that the test report may be forwarded to the requesting clinician so that I can be offered the most appropriate advice.
v. I am not receiving any compensation as the participant nor will I be owed any funds, at this moment or in the future, due to any invention(s) resulting from research and development using my specimen(s).
vi. I understand that the results of this study may be used for medical or scientific purposes, may be presented, for example, at meetings, in scientific publications, and that they may be reported or published; however, I shall not be personally identified in any way, either individually or collectively.
vii. I have been informed that this informed consent can be withdrawn at any time.

I acceptI do not accept

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