Citizen Science Discount Form

Name on Order*
Please enter the name associated with the order this consent will apply to. This information is only used for validity against the order.
First Middle Initial (if Applicable) Last
Date of Birth*
Please enter the Date of Birth associated with the order this consent will apply to. This information is only used for validity against the order.
Email*
Please enter the email associated with the order this consent will apply to. This information is only used for validity against the order.
Consent to Submit Anonymous Data*
By checking the box below, I agree to submit my anonymized data for the order specified in this form to the Citizen Science Data Archive (CSDA). This CSDA data will include demographic and resulting bloodwork, but will NOT include First/Last Name, Date of Birth, City, and/or any contact information to ensure anonymity.
Terms and Conditions (Terms and Conditions).
I agree to the Terms and Conditions.
Add Citizen Science Discount Opt-In to Which Order?*
Enter the order number this demographic data and consent should be applied to.
Height Units*
- Feet and Inches
- Centimeters
Height Feet (1 of 2)*
Height Inches (2 of 2)*
Height (cm)
Weight Units*
- lbs (pounds)
- kg (kilograms)
Body Weight (lbs)*
Body Weight (kg)*
Please select the option that currently best describes your body type.*
- Average
- Athletic & High Body Fat %
- High Body Fat %
- Lean & Athletic
What best describes your weight status?*
- Weight Stable
- Gaining
- Actively Losing
About how many hours will you be water-only fasted for this blood test?*
“Water-only” means no coffee, tea, food, or anything other than water and electrolytes.
How many cups of coffee do you typically consume daily?*
Enter 0 if not a coffee drinker
Do you consume liquid fats (cream/butter/oils) in beverages?*
This would also include adding e.g. tallow to broth, or other drinkable liquids.
- Several times weekly
- Once or twice a week
- Very rarely
- Never
Diet Type*
Please select the option that best describes the diet you will be following leading up to the blood test. Note if you’d like to add specifics, you can do so in the “additional notes” section at the bottom of the form.
- Standard American Diet
- Mediterranean Diet
- Paleo Diet
- Low Carb (21-100g carb/day)
- Ketogenic Diet (0-20g carb/day)
- Carnivore Diet
- Plant-Based Diet
About what percent of your calories are protein?*
- 0-10%
- 11-20%
- 21-30%
- 31% and above
How long have you been on this diet?*
What type of exercise do you engage in weekly?*
E.g. hiking, HIIT, weight lifting, resistance training, running. Feel free to also include frequency per week. If no regular exercise, put down “sedentary”.
Additional notes
Have anything else you’d like to share? Doing an experiment? Feel free to put anything else relevant here.

Retroactive Demographic Data Consent and Opt-in v2022