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    Kindly fill out the questionnaire below:

    Contact information

    Medical and Nutritional Questionnaire

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

    Do you suffer from:
    1. Acne

    2. Psoriasis

    3. Eczema

    4. Atopic dermatitis

    5. Autoimmune diseases (Chron's Lupus, etc.)

    6. Have you taken antibiotics in the last 2 months?

    Data Consent form - Research Purposes

    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 pseudo anonymized, 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.

    Kindly read the full consent on this link: Data Consent and give your acceptance below to proceed with the questionnaire.

    Have you read the Data Consent?

    Do you accept the terms in the Data Consent?