Informed Consent Form for Genetic Testing / Reporting

Intrinsic Genomics

Genetic Testing & Reporting — Consent to Collect & Use Genetic Data

Version: 20251010
Consent ID / Version Number: Consent1.5

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1. Introduction & Voluntary Nature

You are being asked to provide your explicit, informed consent for Intrinsic Genomics to collect, analyze, store, and use your genetic data (e.g., DNA or genotype/sequence data) in order to generate reports and related services. Participation is voluntary. You may decline or withdraw consent at any time without penalty or loss of benefits.

2. What Genetic Data Will Be Collected

• Biological specimen (e.g. saliva, buccal swab, blood)
• Raw genetic data (e.g. genotype calls, sequence data)
• Derived data (e.g. variant annotations, risk scores)
• Self-reported health / family history data (if applicable)

3. Purpose & Use of Genetic Data

Your genetic data will be used for the following primary purposes (you must check or affirm consent):

• To generate the personalized risk reports you have ordered
• To compare against population data to interpret risk
• To store for future access and report generation
• To allow you to access your results online

4. Access & Sharing

Your data may be accessed by:

• Qualified internal staff/analysts under confidentiality obligations
• Lab partners / processors who are contractually bound to your permitted use
• No third party will receive your data unless you explicitly consent (see below)

You may, if you choose, provide additional consent for:

• Research uses of your de-identified data
• Sharing with third-party collaborators (only with your explicit consent)
• Use of your data for marketing or promotional purposes

5. Storage, Retention & Destruction

• We will retain your genetic data and sample for a minimum of 3 years unless you withdraw consent.
• After that period or upon consent withdrawal, your data will be securely deleted or anonymized.
• If you revoke consent for storage, we will remove your data within 30 days.

6. Risks, Benefits & Limitations

Risks

• Possibility of re-identification (though we use de-identification and security measures)
• Psychological impact of learning about predisposition or risk
• Potential discrimination (insurance, employment) although protections such as GINA may apply
• Data breach or unauthorized access (we use encryption and security protocols)

Benefits / Limitations

• You receive a personalized genetic report.
• The results do not guarantee disease or protection — they are probabilistic.
• Your results may evolve over time as science advances.

7. Right to Withdraw / Revoke Consent

You may withdraw consent at any time, in part or in full, by contacting us at info@intrinsicgenomics.com. Upon revocation:

• We will cease further use of your genetic data
• We will delete your data within 30 days
• Any reports you've already downloaded may remain in your possession (but no further new analysis or uses will be made)

8. Authorization & Signature

By signing below (or electronically checking "I consent"), you confirm that:

• You have read and understood this consent form
• Your questions have been answered to your satisfaction
• You voluntarily agree to the collection, use, storage, and disclosure (as specified) of your genetic data
• You may download or print a copy of this consent form for your records