* Country
Canada
United States
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Northern Mariana Islands
Norway
Oman
Pakistan
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Panama
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Peru
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Pitcairn
Poland
Portugal
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Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
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Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Client Consent Form Each client is required to read, acknowledge, and agree to the terms in this Consent Form before his/her sample can be processed. This ensures each client knows what to expect, understands the process, is aware of the benefits, limitations and potential risks, and understands fully the service being provided before agreeing to proceed.
By agreeing to the conditions in this form, the client authorizes Nutrigenomix to:
Analyze his/her DNA for specific nutrition and physical activity‐related genetic markers. Store his/her anonymized DNA sample in a safe and secure location, so that as the science develops he/she will have the option of having additional tests. You may request to have your sample destroyed by emailing [email protected]
What are the benefits?
Following the nutrition and physical activity recommendations based on the results of the genetic test has been shown to reduce the risk of chronic disease and promote optimal health and performance. Research also shows that individuals who receive DNA‐based dietary advice find the information more motivating to adopt healthier eating habits, and make more changes to their diet compared to when they are given general population‐based dietary advice.
What are the risks?
There are no known risks associated with Nutrigenomix testing. Some individuals may worry that their genetic information could be used to discriminate against them in their job or for health insurance coverage. In the United States, the Genetic Information Non‐discrimination Act (GINA) was signed into law in May of 2008 and offers federal protection against such discrimination. In Canada, the Genetic Non‐Discrimination Act (GNA), formally known as Bill S‐201, was passed into law on May 4, 2017. GNA protects individuals from insurance companies and employers from using, requesting or requiring genetic test results. Note: Nutrigenomix does not test for genetic predisposition to certain disease. The test only includes genes related to nutrition and physical activity. Nevertheless, if an individual has a Nutrigenomix test, he/she is required to answer ‘yes’ on any legal forms or questionnaires that ask whether they have had a genetic test.
What are the limitations?
Nutrigenomix testing is not intended to treat, prevent, mitigate, or cure disease. Nutrigenomix does not provide medical advice, diagnosis or treatment. The test looks at 70 genes that have been shown to modify response to dietary intake and/or to impact nutrition and physical activity recommendations. The development of chronic diseases can be influenced by many factors, including genetics, diet and lifestyle. Following the recommendations provided does not guarantee absence of disease. The test results are based upon probabilities, and may not provide a 100% definitive conclusion to either elevated or typical risk.
How will the information be protected?
All personal health information, including Nutrigenomix test results, is protected by the healthcare professional providing the test. Each sample is anonymized using a barcode and this is entered into a password protected online system. Nutrigenomix uses a Secure Socket Layer (SSL) protocol to encrypt information that is transmitted over the Internet. This technology uses 256‐bit encryption, which ensures that confidential information and transactions cannot be viewed, intercepted or altered. Nutrigenomix will never reveal client information or genetic data to a third party except as required to provide the services requested, or as required by law.
What will happen to the DNA sample once the client has received the results?
After testing is completed, Nutrigenomix will store the anonymized sample under secure conditions to enable future testing as new markers are discovered. Nutrigenomix will never share your data with any third party and will never conduct research using your DNA without your permission.
Refund Policy
All sales are final. All Nutrigenomix tests and services are non-refundable.
Client Consent I have read, or have had read to me, all of the above statements and understand the information regarding Nutrigenomix testing. I have had the opportunity to ask any questions I have about the testing, procedure or risks prior to providing my consent. By providing my saliva or buccal swab sample I am consenting to Nutrigenomix testing and storage of my sample for future testing. By clicking the box below, I consent to having my Nutrigenomix report sent to me via email by my healthcare practitioner, which I understand is not a secure form of communication. I understand that only my first name is indicated in the report and no other identifying information is included.
