I certify that the information provided is accurate to the best of my knowledge. I understand that only licensed healthcare professionals are authorized to request laboratory tests, and I will comply with all applicable federal, state, and local laws governing such requisitions. I consent to receiving signal intensity values for the test and acknowledge that these values are not validated for clinical utility and are not cross-comparable with other assay methods.

I confirm that the test has been lawfully requisitioned following an examination of the patient and/or their records, as necessary for the patient's health.

I affirm that the information provided is accurate. I acknowledge that only licensed healthcare professionals can request lab tests and agree to follow all applicable laws.

I consent to the use of the submitted sample and any de-identified, aggregated data for public health, scientific, and quality purposes. No protected health information will be shared beyond what is necessary for testing and billing.

My healthcare provider (or designee) has explained: (a) the purpose and use of the test; (b) the accuracy and limitations of results; (c) medical risks and benefits; (d) that it tests for Type 1 diabetes; (e) the option of counseling before signing; and (f) that a positive result may indicate a predisposition or diagnosis of T1D.

I certify that I (or my dependent) have insurance and assign benefits to Enable Biosciences, Inc. for services. I understand I am responsible for any charges not covered by insurance. I authorize the release of information for payment and use of this signature for insurance submissions.

I have been informed of the test’s purpose, benefits, and risks, received a copy of this consent, and had the opportunity to ask questions. I voluntarily agree to T1D autoantibody testing.

I affirm that the information provided is accurate. I acknowledge that only licensed healthcare professionals can request lab tests and agree to follow all applicable laws.

I consent to the use of the submitted sample and any de-identified, aggregated data for public health, scientific, and quality purposes. No protected health information will be shared beyond what is necessary for testing and billing.

My healthcare provider (or designee) has explained: (a) the purpose and use of the test; (b) the accuracy and limitations of results; (c) medical risks and benefits; (d) that it tests for Type 1 diabetes; (e) the option of counseling before signing; and (f) that a positive result may indicate a predisposition or diagnosis of T1D.

I have been informed of the test’s purpose, benefits, and risks, received a copy of this consent, and had the opportunity to ask questions. I voluntarily agree to T1D autoantibody testing.