BPT X GutID Parkinson's Study

Thank you for participating in the Beat Parkinson's Today X GutID Parkinson's 2026 Microbiome Study, and for taking the time to answer these questions.

Please know that this process is HIPAA compliant, and your information is protected accordingly.

The questions have been designed to be answered quickly, and please don't over think answers. Please be sure to complete the form in one sitting, as your answers will not be saved if you do not complete the form fully. After completing each section hit the next button to proceed. On the last page, please hit submit to complete the process.

Once you have submitted this form, you will be shipped a fecal and saliva collection kit for you to collect your samples and return to us in a prepaid envelope.

By developing further understanding of the Parkinson's association with the microbiome, we hope to advance the understanding of the disease, help improve diagnostics, and potentially identifiy therapeutic leads.

The GutID Team

GutID is by Intus Bio. To learn more please visit intusbio.com
CONSENT TO PARTICIPATE IN RESEARCH

Intus Biosciences/GutID Consent to Participate in Research

Consent Document - Key Points

Intus Bio/GutID aims to make and support scientific discoveries and publish those discoveries in scientific journals. We invite you to take part in this project, which we call Intus Bio/GutID Research. To get started you must agree to the terms in our full consent document (below) that are part of our overall Terms of Service, which you agree to during the checkout process. Please note that any capitalized terms have the definitions given in the Terms of Service and the Privacy Policy. Here are key points you need to know to participate in research:

How do I take part in Intus Bio/GutID Research?

•       Take health surveys or questionnaires or otherwise enter health or demographic information about yourself into the Intus Biosciences/GutID website (“Self-Reported Health Information”). You choose which surveys to take and which questions to answer.

Can my child take part in Intus Biosciences/GutID Research?

•       Your child may take part in Intus Biosciences/GutID Research if he or she gives assent to participate and a parent or legal guardian authorizes Intus Biosciences/GutID to use his or her Microbiome & Self Reported Information for research. For purposes of this consent document, “Your” includes your child, if you are consenting on their behalf.

Which of my personal information is used for research?

•       The following may be analyzed in the research:

o      Test Results. These are the results we receive back from the laboratories that have analyzed your samples.  Analysis of samples includes the extraction and sequencing of bacterial DNA found in the samples. The Test Results will be the sequenced bacterial DNA from your sample.  This will be DNA relating to your microbiome - for example enabling us to identify populations of bacteria in your gut.

o      Self-Reported Heath Information. This is information such as height, weight, age, what you eat, and pre-existing health conditions as collected within the health questionnaire.

•       Your name and contact information may be used to communicate with you but are not analyzed in combination with your Test Results and Self-Reported Health Information.

Who gets to see my personal information?

•       Intus Biosciences/GutID's Privacy Policy outlines who does and does not get access to the personal information of Intus Biosciences/GutID customers; here we list the additional individuals who will get access if you consent to take part in research.

•       Within Intus Biosciences/GutID and Intus Biosciences/GutID Third Party Labs: Intus Biosciences/GutID researchers who conduct analyses will have access to your Test Results and Self-Reported Health Information, but not to credit card information. Intus Biosciences/GutID researchers who contact you will have access to names and contact information, but only to very limited Test Results or Self-Reported Health Information.

•       Outside of Intus Biosciences/GutID:

Intus Biosciences/GutID may share Test Results and Self-Reported Health Information to carry out research into diet and/or health including academic research organizations (such as universities) and pharmaceutical companies, for example to assist in the development of new medications or diagnostic assays for particular diseases. When we do this your data will be anonymized.  In some cases, anonymized data may be uploaded to public databases as part of the peer-review process. For example, if a scientific advancement using the data is considered by scientific journal reviewers and editors and deemed suitable for publication, standard practice requires that the data behind the study be posted to support the results of the publication. All data posted to public databases will be anonymized.

How will I benefit from this research?

•       By taking surveys you may learn about Intus Biosciences/GutID's research findings, including how your answers compare with those of others and new discoveries made by Intus Biosciences/GutID's research program.

•       Sometime in the future you or your family may benefit indirectly from research discoveries made by Intus Biosciences/GutID or its research partners.

What are the risks of taking part in this research?

•       There is a very small chance that someone with access to the research data or results could expose personal information about you. Intus Biosciences/GutID has security policies and practices in place to minimize the chance of such an event.

Can I stop taking part in Intus Biosciences/GutID Research?

•       Yes, you can withdraw yourself, your child, or your pet from Intus Biosciences/GutID Research at any time. Any of your data that have already been used as part of a study cannot be withdrawn, but your data will not be included in studies that start more than 30 days after you withdraw (it may take up to 30 days to withdraw your information after you withdraw your consent). To withdraw, simply send your request to Ask@GutID.com.

Full Consent Document
One of Intus Biosciences/GutID's missions is to make and support meaningful scientific discoveries by enabling its customers to participate directly in research. Intus Biosciences/GutID has enrolled participants from among its customers in this project, which we call Intus Biosciences/GutID Research. Specifically, Intus Biosciences/GutID Research refers to research aimed at publication in peer- reviewed journals and research funded by the federal government (such as the National Institutes of Health). Intus Biosciences/GutID Research aims to uncover connections among various human and animal health issues and lifestyle choices and the gut microbiome, in order to further the overall science and understanding of the role that the gut microbiome plays in health and wellness and for the development of new medications or diagnostic assays for particular diseases.

For further details on Intus Biosciences/GutID's other uses of personal information, see our Privacy Policy.

Intus Biosciences/GutID seeks your voluntary participation in Intus Biosciences/GutID Research. This document explains the following items:

1.     What you are agreeing to if you consent,

2.     How you can participate,

3.     How your data will be used,

4.     How we protect your data and keep it private,

5.     The benefits and risks of participation,

6.     Your options and how to withdraw, and

7.     Who to contact if you have questions.

1.     What am I agreeing to if I consent?

Giving consent by agreeing to the Terms of Service at checkout and/or registration means that you agree to let Intus Biosciences/GutID researchers use your Test Results & Self-Reported Health Information for Intus Biosciences/GutID Research, as described above. "Test Results & Self-Reported Health Information" refers to:

•       Your Test Results

•       Self-Reported Health Information, including health information you enter into surveys, forms and other features as well as demographic information you share such as age and ethnicity.

We may also use the results of further analysis of your sample in Intus Biosciences/GutID Research. Your Test Results & Self Reported Information does not include identifying Registration Information you provided when you purchased a test or created an account (such as name, address, email address, user ID, password, or credit card information).

2.     How do I participate?

Participation consists of (1) allowing Intus Biosciences/GutID researchers to use your Test Results & Self-Reported Health Information for Intus Biosciences/GutID Research, and (2) entering data about yourselfor your child, into Intus Biosciences/GutID Research features on the Intus Biosciences/GutID website, or submitting it to Intus Biosciences/GutID through various features. These features include surveys, individual questions, and other features where you enter information. If you do not feel comfortable providing a piece of information, you may choose not to answer that question. You may choose to take all, some, or none of the surveys.

Intus Biosciences/GutID Research is open-ended: new surveys and features may be added on a continuing basis. If new surveys or features are added, you may receive an email update or see an announcement when you sign into your account. We might invite you to participate in a specific study if your Test Results & Self-Reported Health Information matches the area of interest. If you wish not to be contacted about future studies, please opt-out of these communications by emailing us at Ask@GutID.com

Your participation in Intus Biosciences/GutID Research is completely voluntary.

3.     How will my data be used in Intus Biosciences/GutID Research?

Your Test Results & Self-Reported Health Information may be used to discover links between the gut microbiome and various states of health and wellness, lifestyle choices and biology and for the development of new medications or diagnostic assays for particular diseases. Discoveries made as a result of this research could be used to understand the basic causes of disease, develop drugs or other treatments and/or preventive measures, predict a person's risk of disease or screen for whether a person has a specific disease. The topics to be studied span a wide range of traits and conditions, from common to rare. Some of these studies may be sponsored by or conducted on behalf of third parties, such as non-profit foundations, academic institutions or pharmaceutical companies.

This study may cover potentially sensitive topics. In the event we collect this type of sensitive information, Intus Biosciences/GutID and its research partners will protect the privacy of this information in accordance with applicable laws.

4.     How do you keep my data protected and private (whether or not I consent)?

Intus Biosciences/GutID's Privacy Policy in its Terms of Service outlines how the company protects your privacy while conducting business, such as providing our services to you. Intus Biosciences/GutID uses a range of physical, technical, and administrative procedures to protect the privacy of your personal information, including your Test Results and Self-Reported Health Information.

If you agree to participate in Intus Biosciences/GutID Research, Intus Biosciences/GutID researchers can use your data for research that will be published in scientific journals, or that is sponsored by the National Institutes of Health and certain other organizations. In the event any research is published, we will not include any identifying information that would make it likely that anyone could identify you or your child.

Just as Intus Biosciences/GutID aims to minimize the chances of a privacy breach while conducting its business, Intus Biosciences/GutID researchers aim to minimize the chances of a privacy breach while conducting research. Here are the main ways we do that:

•       The Intus Biosciences/GutID researchers who conduct the statistical analyses do not utilize Registration Information (name, address, email address, user ID, password, or credit card) of customers,

•       Intus Biosciences/GutID researchers who interact with research participants and conduct interviews have access to names and contact information of participants, but only to very limited Test Results and other personal information necessary to conduct interviews

•       To minimize the chance that an external person can determine that any particular customer is part of a study, Intus Biosciences/GutID researchers either:

o publish only data de-identified and pooled across multiple customers, or

o publish only very limited, non-identifying information of a single individual

5.     What are the benefits and risks of participation?

Benefits: One of Intus Biosciences/GutID's missions is to make meaningful scientific contributions by enabling its customers to participate directly in microbiome research. If Intus Biosciences/GutID publishes study results in peer-reviewed journals, there may be an indirect benefit to you as scientific knowledge increases and/or new drugs or tests are developed. You may also have the opportunity to acquire one or more of the following, in return for some level of participation in the research:

•        Comparison of your Self-Reported Health Information responses to those of all responders, additional information about the microbiome, microbiome research or the Intus Biosciences/GutID study, and/or preliminary research findings (all other participant responses will have all personal identifier removed before comparisons are shared with you), and

•        There may be additional benefits to participation that are currently unforeseeable.

Based on the results of this study, Intus Biosciences/GutID may develop intellectual property, including but not limited to patents, copyrights and trademarks, and/or Intus Biosciences/GutID may commercialize products or services, directly or indirectly. In such cases you will not receive any compensation.

Risks: There are some potential risks to participating in Intus Biosciences/GutID Research, including the following:

•        Some survey questions or data comparisons may make you or your family members uncomfortable.

•        Your Test Results, Self-Reported Health Information, and/or personally identifying information may be compromised in the event of a security breach. In the event of such a breach, if your data are associated with your identity, they may be made public or released to third parties. In addition, if you or a family member has Test Results linked to your name or your family member's name in a public database, someone who has access to your Intus Biosciences/GutID Test Results might be able to link that data to your name or your family member's name through the publicly available research data. Although Intus Biosciences/GutID cannot provide a 100% guarantee that your data will be safe, Intus Biosciences/GutID has strong policies and procedures in place to minimize the possibility of a breach.

•        When Intus Biosciences/GutID researchers publish results from this ongoing study, they may include your Test Results & Self-Reported Health Information but only as part of a summary across enough people to minimize the chance that your personal information will be exposed. Identification of your individual-level data from those summaries would be extremely difficult, but it is possible that a third party that has obtained some of your microbiome data could compare that partial data to the published results and infer some of your other personal information.

•        As with any online service, if you disclose your account password to others, they may be able to access your account and your Microbiome & Self- Reported Information.

•        There may be additional risks to participation that are currently unforeseeable.

None of the surveys or other procedures used by the researchers in Intus Biosciences/GutID Research is invasive or experimental. The procedures involved do not involve more than the minimal risks described above.

6.     Do I have any alternatives? Can I withdraw from this study?

Your alternative is not to participate in Intus Biosciences/GutID Research. If you choose not to give consent for Intus Biosciences/GutID Research, your Test Results & Self-Reported Health Information may still be used for other purposes, as described in our Privacy Policy. If you do give consent to participate in this study, you may choose not to take Intus Biosciences/GutID Research surveys or use other Intus Biosciences/GutID Research features.

At any time, you may choose to change your consent status to either take part in Intus Biosciences/GutID Research or to withdraw all or some of your Test Results & Self-Reported Health Information (including your Sample) from Intus Biosciences/GutID Research. Simply send an email to Ask@GutID.com to make such request. If you withdraw all or some of your Test Results & Self-Reported Health Information, Intus Biosciences/GutID will prevent that information from being used in new Intus Biosciences/GutID Research initiated after 30 days from receipt of your request (it may take up to 30 days to withdraw your information after you withdraw your consent). Any research on your Test Results & Self-Reported Health Information (including your sample used to generate the Test Results) that has been performed or published prior to this date will not be reversed, undone, or withdrawn. Choosing not to give consent or withdrawing from Intus Biosciences/GutID Research will not affect your access to your Test Results or to the Intus Biosciences/GutID Services.

In addition, Intus Biosciences/GutID Research may be terminated without your consent. In the following cases, Intus Biosciences/GutID will maintain your Test Results & Self-Reported Health Information according to the terms of our Privacy Statement:

1.     Transfer of ownership. If Intus Biosciences/GutID undergoes a business transition such as an acquisition or merger, Intus Biosciences/GutID Research may be terminated. In such case, your personal information would remain subject to the promises made in any preexisting Privacy Policy.

2.     Termination of service. Intus Biosciences/GutID may terminate your access to the Intus Biosciences/GutID Service for any reason in its sole discretion. If your access to the Intus Biosciences/GutID Service is terminated for any of these reasons, your participation in Intus Biosciences/GutID Research may also be terminated.

7.     Who do I contact if I have questions?

If you have general questions and need help with Intus Biosciences/GutID's service, please contact:

·       Ask@GutID.com

·       If you have any questions or concerns about Intus Biosciences/GutID Research, if you suffer a research-related injury, or if you have a question about subjects' rights, please contact the following:

·       Intus Biosciences/GutID Human Protections Administrator:

o Email: Ask@GutID.com

PLEASE READ CAREFULLY BEFORE CLICKING AGREEING TO OUR TERMS OF SERVICE AGREEMENT:

By clicking “I Agree,” for our Terms of Service agreement, I also confirm that I have read and understand this Intus Biosciences/GutID Consent to Participate in Research. If I am consenting to allow my child to participate in Intus Biosciences/GutID Research, I am authorized to consent on behalf of my child, and I have discussed the study with him/her. If my child is thirteen years or older, my child has agreed (“assented”) to take part.

I understand my or my child’s participation is voluntary, and that I am free to withdraw myself or my child at any time, without giving a reason, and without affecting my access to other Intus Biosciences/GutID Services. I understand that by clicking “I agree” I am not waiving any legal rights that I or my child otherwise have.

I understand that information described above, including my Test Results, will be viewed by responsible individuals representing the Intus Biosciences/GutID or its research partners, supervisory bodies, or regulatory authorities where it is relevant to taking part in this research.

I agree that my or my child’s Microbiome Results & Self-Reported Information (including the Samples) may be used as described in this Intus Biosciences/GutID Consent to Participate in Research and the accompanying Privacy Policy and Terms of Service.

I can print a copy of this Intus Biosciences/GutID Consent to Participate in Research to keep for my records.

*This Intus Biosciences/GutID Consent to Participate in Research was last updated on February 21, 2025
Details
Name

First NameLast Name
Shipping Address for Collection Kit

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
What is your email address?
example@example.com

Open-Ended Questions 8/8
Are you suffering or have suffered in the past from any oral diseases or disorders, such as gingivitis (gum bleeding and inflammation), tooth decay, infections, halitosis (bad breath), or fungal infections (oral thrush)? Please describe your experience/symptoms regarding whichever oral diseases apply.
Have you had any dental procedures such as implants, dentures, fillings, etc. performed? Please describe which (if any). Otherwise, leave this question blank.
Do you use any specific products for your oral health or hygiene, such as particular toothpaste, mouthwash, or oral probiotics, etc.?
Have you ever had an oral microbiome or oral health test conducted? If so, please provide the results.
What was the first PD symptom that you or any member of your family noticed?
Are there any family members with PD or other neurodegenerative diseases such as Alzheimer's disease or other forms of dementia, Huntington's disease, or Amyotrophic Lateral Sclerosis (ALS)?
Could you please describe the consistency and color of your stools? Is there a pungent or peculiar smell to them? Have you noticed that your stools contain indigested food?
Have you noticed any new or worsening symptoms related to your gut function and digestion? If so, please describe them.
What is your typical diet like? Do you follow a specific diet such as carnivore, keto, paleo, Mediterranean, standard American diet, etc.?
What are the foods you consume and/or crave most frequently?
Are there any particular foods or beverages (such as caffeinated beverages, alcohol, carbonated drinks, etc.) that make you feel worse? The symptoms could range from digestive problems to sleep disturbances, low mood and energy, decreased stability, etc.?
Is eating at certain times making you feel better or worse? For example, if you eat late at night, do you feel more lethargic or tired?
Do you notice any correlation between your PD symptoms and your digestive or gut function?
Have you ever been affected by a specific infection? Please describe the experience, if applicable.
Have you been exposed to specific chemical substances or a polluted environment? Please describe.
Do you take any prebiotics, probiotics, or postbiotics (e.g. butyrate)?
Do you take any other supplements or medications? Please provide a list of them.
What oral health problem bothers you the most?
What intestinal or digestive problem bothers you the most?
Please indicate any additional comments or concerns below.
Thank you again for your participation.
Should be Empty: