NAD+ Testing Registration Form

Blood Sample Collection For NAD+ Testing

Please enable JavaScript in your browser to complete this form.

Sample ID generated anonymous by i-DNA

Fill by i-DNA lab

Name as appear in ID or passport

First

Last

Last 4 alphanumeric character of ID or passport

Date of birth

supplement? Name Collection

Gender

Ethnic group (select one)

If other…

Are you taking NMN or NAD+ supplement?

Yes
No
Undecided

Height (cm)

Weight (kg)

Mobile number

Specimen type:
2ml venus blood collected in K2 EDTA vacutainer

Purpose of collection:
Measurement of NAD+ and NADH for personal use
(what is NAD+ and NADH?)

Collection date:

Collection by:

Report send to email

Send sample on wet ice to testing Laboratory:
i-DNA Biotechnology Pte Ltd.
237 Pandan Loop, 07-08 Westech Building,
Singapore 128424
Attention: NAD+ Testing

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:
I, the undersigned, confirm that:

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

Consent