Dysbiosis Test Registration Name *ID number *Email Address *Primary PhonePhoneClinic Name *Please choose from these conditions: *No symptoms and want to prevent metabolic and inflammatory issues.I was diagnosed to have Irritable Bowel SyndromeI was diagnosed to have Inflammatory Bowel Disease (specify type in comments)I am diabetic (specify type in comments)I have symptoms of gut disordersCommentsSampler Registration Number *Sample collection date. Written on the sample. *Are you following the Gut Restore program? *YesNoNo, but I am on the cholesterol and lipid profile programI started the recommended omega-3 rich oil onLearn about the Gut Restore Program *Please send me information via emailPlease send me link to FREE Health talksPlease send me offers and invites for eventsI would not like to be sent any additional informationPlease tick for your consent *my data can be sent to the licensed laboratories for processing with sample.my data can be referred for following additional tests.to be notified with future program updates and further development of new services.Consent *All data will be processed in accordance with the Data Protection Act, Chapter 586 of the Laws of Malta. You have the right to request correction or erasure of such data, in line with the Data Protection Act 586. I understand that data will be stored safely at the laboratories owned or subcontracted by Omnigene Medical Technologies Ltd. I declare that I provided information on any medical condition and that the blood profile is normal. The progam and supplementation will be discussed during the first consultation and any medical advice required will be discussed with my general practitioner before consumption of supplements.Register
