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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. Polycystic ovarian syndrome

    2. Endometriosis

    3. Do you have any chronic medical conditions (e.g. diabetes, hypertension, autoimmune disorders, etc.)

    List of chronic medical conditions

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

    5. Are you currently taking any meditation or supplements?

    List of medication and/or supplement/s

    6. Have you experienced any vaginal infections in the last 2 months?

    7. Are you currently menstruating?

    8. Do you have a regular period (not less than 21 days and not more than 35 days)?

    9. What type of vaginal hygiene products do you use?

    10. Do you use contraceptives, such as; IUDs (intrauterine devices) or hormonal contraceptives?

    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?