Enrollment

PURPOSE OF BROAD CONSENT

In this study, we collect data that is considered identifiable and private. Your data (or your child's data, if applicable) are identifiable because they contain demographic information and health history. Although your name and other direct identifiers will be removed, we are unable to remove every piece of information that would allow identity to be figured out. We would like to keep, use, and share this identifiable, private data for future unspecified research, including providing annual data analysis sets for public knowledge.

DATA COLLECTED FOR PUBLIC DATASET

• Allergy test results (88-panel comprehensive testing)
• Patient health history relevant to allergy research
• Demographics (age range, region, general health indicators)

IF YOU PROVIDE BROAD CONSENT

We will: store and maintain your data indefinitely; use your data for future research; share your data with researchers, institutions, and companies; provide annual public data analysis sets. You will not be told purposes or results of specific studies. Your data may be used to create products/services that are sold. There are no plans to compensate you.

VOLUNTARY PARTICIPATION

I acknowledge that I am voluntarily participating in the 88-Panel Allergy Testing Study conducted by Hope for Allergies. I confirm that I am here of my own free will, have not been coerced to participate, and understand I may withdraw at any time without penalty.

PARTICIPANT INCENTIVE PROGRAM

As appreciation for my participation, I understand I am eligible to receive:

TERMS

Gift cards are non-transferable with no cash value. Gift Card #1 requires completion of allergy testing. Gift Card #2 requires physician sign-off on results. I will be notified when Gift Card #2 is available.

Allergy skin testing will be administered at this medical facility with a medical physician or other healthcare professional present due to the possibility of mild/severe reactions that may require immediate medical attention.

Possible reactions may include:

• Itchy eyes, nose or throat
• Nasal congestion, runny nose
• Swelling of the face, lips, tongue, or throat
• Tightness in the throat or chest
• Increased wheezing
• Lightheadedness, faintness
• Nausea and vomiting
• Hives, generalized itching
• Shock (under extreme circumstances)

Please inform the Allergy Care Specialist or your provider if you are:

• Currently pregnant or may be pregnant
• Currently taking beta-blockers
• Immuno-compromised

Our office is required by law to collect all co-pays, deductibles and co-insurances. All payments are due at the time of visit. Insurance coverage is never a guarantee. If your insurance does not pay for services rendered, you will be responsible for payment.