TruDiagnostic - Register Kit

Have you taken this test before? *

Yes

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TruDiagnostic conducts extensive research to identify the connections between epigenetic changes and health. By completing your Health Survey, you join other TruDiagnostic research participants in driving discoveries with the potential to lead to life-changing treatments.

Personal Information

This survey is confidential and your information is privacy protected.

What is your biological sex? *

Male

Female

What is your home address? *

City *

Country *

State *

Zip Code *

What is your phone number? *

opt-in to receive text messages about your order

Agree

Enter Your Barcode *

Make sure to include all three lines of the barcode with no spaces. For example,

"000112345ABCDEFG". See the image to the right for reference.

Who is your physician? *

Medications List *

Selected Medications List:

What dosage are you taking?*
(ex. 10 mg)

Dosage Value

Dosage Unit

I don't know

How often do you engage in treatment?*
(ex. 2 times per day)

Frequency Valuetimes per

Frequency Time period

I don't know