Questionnaire

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

    Date of Examination:

    Personal information


    Preferred communication method (primarily for scheduling the pickup of the test kit and sample delivery):

    Birth sex:

    Female - Please collect a vaginal swab from The BioArte Limited laboratories in San Gwann (https://maps.app.goo.gl/QTHVYWuX4HMyP8uj7).

    Male - Please collect a sterile urine container from The BioArte Limited in San Gwann (https://maps.app.goo.gl/QTHVYWuX4HMyP8uj7) or purchase the sterile urine container (at least 30 ml) at the pharmacy of your choice.

     

    Sample Instructions
    Vaginal Swab: Please collect the specimen following the provided instructions.
    Urine Sample: Collect the first urine of the morning in the sterile container provided and drop it at the BioArte Laboratories within 1-2 hours max from collection. Keep the sample at max 25°C.

    Consent to Personal Data (Mandatory)

    i. I have been fully informed about the Sexual Transmitted Infection Test, including its purpose, procedure, limitations, costs, and the implications of the results.
    ii. I acknowledge 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 Sexual Transmitted Infections 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 contact information above.

    Signature (using full name) and date: