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Patient Registration & Informed Consent

Format: +[Country Code] [Number]. Example: +254712345678. Only numerical digits allowed after the +.

Sample Collection Method

Payment Method

C. Informed Consent for Sample Storage & Data Use

Please read the following terms carefully. You must scroll to the bottom of this document to unlock the signature fields.

Queries regarding data privacy or your rights under the Kenya Data Protection Act should be directed to our Data Protection Officer at mshai@chlosyneafrica.com.