NAD+ Testing Form

Sample ID generated anonymous by i-DNA

or laboratory in

Name as appear in ID or passport

Last 4 alphanumeric character of ID or passport

Date of birth

Gender

Ethnic group

Height (cm)

Weight (kg)

Mobile Number

Email

Specimen type

2ml venus blood collected in K2 EDTA vacutainer

Purpose of collection

Are you taking NMN supplement?

Yes
No

Collection method

Collection date

Collection by

Send sample on ice to testing laboratory

237 Pandan Loop, 07-08 Westech Building, Singapore 128424

Report send to (email)

Disclaimer

i-DNA shall use your blood sample to perform the ELISA assay manufactured by NADMED Ltd. The left over blood sample shall be discarded. Your information may be used by i-DNA to further improve this technology. You shall indemnify and hold i-DNA harmless from and against any and all claims, damages, costs, expenses and other liabilities with respect to this test and the result produced.

Consent declaration

1. I have been informed and agreed about the purpose and procedure of the blood collection.
2. I understand that a trained healthcare professional will perform the venipuncture.
3. I have been made aware of potential risks, including minor discomfort, bruising, or, in rare cases, infection at the puncture site.
4. I consent to the collection of my blood and its use for the specified purpose.
5. I understand that my personal information and this test report will be kept confidential and used solely for the intended purpose.

Date (DD/MM/YYYY)

TẦM NHÌN – SỨ MỆNH

GIÁ TRỊ CỐT LÕI

SẢN PHẨM – DỊCH VỤ

TƯ VẤN

LIÊN HỆ

i-DNA-Vietnam