Testing kits, sample analysis, and test results are not distributed, collected, conducted, analyzed, or reported by JDRF. JDRF does not assume responsibility for testing outcomes or processes. Any sponsorship from JDRF is solely for the purposes of covering at home testing costs incurred by authorized testing labs. JDRF urges testing users to speak with their healthcare provider for additional information based on the outcomes of their tests.

By signing this Authorization to Release Personal Health Information ("Authorization"), I authorize Enable Biosciences Clinical Reference Laboratory to disclose to JDRF (together with its parents and affiliates), and its third-party business partners, vendors, and other agents ("Agents") information about my disease, including the results of my Autoantibody Test, treatment, insurance coverage and payment for my Autoantibody Test ("my Information"). I understand that Enable Biosciences, Inc and JDRF (including its Agents) may use and disclose my Information for the purposes of providing certain research, education and support services including, but not limited to: determining if I am eligible to participate in the Autoantibody Testing Program ("the Program"); managing and improving the Program; communicating with me about my experience with the Program; sending materials relating to the Program; investigating my health insurance coverage; and operating and administering the Program. I further authorize JDRF to de-identify my Information and use it in performing research, education, business analytics, and marketing studies, or for other commercial purposes, including linkage with other de-identified information JDRF may receive from other sources. I understand that once my Information has been disclosed to JDRF, federal privacy laws may no longer protect the Information from further disclosure, but that JDRF intends to use and disclose my Information only in accordance with this Authorization or as otherwise allowed by law. I understand that I may refuse to sign this Authorization and that a refusal to sign will not affect my ability to obtain medical care, insurance coverage or access to health benefits, including access to therapy. However, if I do not sign this Authorization, JDRF cannot provide me with the specialized education or support services as described above. I understand that this Authorization expires 2 years from the date this Authorization is signed or unless I withdraw (take back) this Authorization before then. Further, I understand that I may withdraw this Authorization at any time by sending a written notice that includes my name, address and phone number, to JDRF, ATT: T1Detect, 200 Vesey Street, 28th Floor, New York, NY 10281. Withdrawal of this Authorization will end further reliance on this Authorization (and my participation in the Program) but it will not invalidate reliance on the Authorization to use or disclose my Information before my notice of withdrawal is received and processed.

JDRF would like to contact you to provide additional information about our programs and events or contact you to conduct clinical or market research. You must be eighteen (18) years or older to opt-in. Your information will not be sold to any third party but may be provided to JDRF partners or regulatory authorities if required. I authorize JDRF to contact me by mail, email, fax, and/or telephone, including calls and text messages (message and data rates may apply) made using an automatic telephone dialing system (autodialer) or a prerecorded voice, at the telephone number(s) provided to provide me with the information I requested and other related information and services or programs that JDRF offers or sponsors, or other topics of interest. I understand that I am not required to provide this consent as a condition of purchasing or donating any property, goods, or services from or to JDRF and that I may participate in the Program if I do not sign this optional marketing authorization. My Personal Data will be processed and stored in electronic databases controlled by or on behalf of JDRF. To learn more about how your information is used or if you decide that you no longer want to receive information about JDRF’s programs and services, please send a letter to JDRF, 200 Vesey Street, 28th Floor, New York, NY 10281.