Required Document

Informed

Required

Before Testing

Legal

Binding Agreement

5-10 min

To Complete

Personal Information

Full Legal Name *

Date of Birth *

Email Address *

Phone Number *

Mailing Address

Test Type *

Understanding and Acknowledgments

I understand the purpose of genetic testing: I understand that genetic testing is performed to analyze my DNA and provide information about genetic variants that may affect my health, medication response, nutrition, and other traits.

I understand testing is voluntary: I understand that genetic testing is completely voluntary and I can decline testing or withdraw my consent at any time before sample processing begins.

I understand the limitations: I understand that genetic testing has limitations, may not detect all genetic variants, and results should be interpreted by qualified healthcare professionals. Results are for informational purposes and do not constitute medical advice.

I understand the risks: I understand the potential risks of genetic testing including psychological impact, privacy concerns, potential for discrimination, and discovery of unexpected information about myself or family members.

Consent Statements

I consent to genetic testing: * I voluntarily consent to have my biological sample collected and analyzed for genetic testing purposes as described in this form.

I consent to sample storage (Optional): I consent to Gene Matrix storing my biological sample for up to 10 years for quality control, re-testing if needed, and future testing services I may order. I understand I can request sample destruction at any time.

I consent to research participation (Optional): I consent to my de-identified genetic data being used for research purposes to advance scientific knowledge. I understand I will not receive compensation and can withdraw this consent at any time.

I consent to communications (Optional): I consent to receive educational materials, updates about new tests, and relevant health information from Gene Matrix. I can opt out at any time.

Legal Acknowledgments

I acknowledge the Privacy Policy: * I have read and understood Gene Matrix's Privacy Policy and HIPAA/GDPR Compliance documentation. I understand how my personal and genetic information will be collected, used, stored, and protected.

I agree to Terms and Disclaimers: * I have read and agree to Gene Matrix's Terms of Service, Medical Disclaimer, and Waiver of Liability. I understand that genetic testing is for informational purposes only and does not constitute medical advice.

Electronic Signature

Type Your Full Name as Electronic Signature *

By typing your name above, you are providing your electronic signature and agreeing to all terms and consents in this form.

Date *

* Required fields must be completed to submit this form

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