Consent for Services

LAST UPDATED: November 9, 2020
Welcome to Day Two’s unique nutrition pilot program ( the “Service”). This form explains how the program works, its benefits, if there are any risks, and your responsibilities. Your participation is voluntary. Please review this form. Your enrollment is not complete until you scroll down below and confirm that you agree to the following terms.

You are giving your consent to use the Service.

Day Two, Inc. (“we,” “us,” or “Day Two”) and its affiliates provide the Service. Our Service is governed by our Terms of Service located at and our privacy policy at govern your use of the service.
By enrolling, you agree to these terms.

What is the Service?
The service benefits you by helping you to control your blood sugar levels through precision nutrition. We analyze your gut microbiome levels along with other biometric information to tell you what combination of foods will help control your blood sugar levels. We deliver these recommendations through our smartphone app.

Who is not Eligible for the Service?
The Service is not available for users who have the following conditions: (a) Taken antibiotics or antifungals within the past three months, (b) Are under the age of 18, (c) Taking fertility treatment, (d) Are pregnant or delivered a baby within the past three months, or (e) Are being treated with short-acting insulin.

How does the Pilot Program Work?
Once enrolled, we will host a kickoff session with you.
You must provide a blood sample and biometric data like height, weight, BMI, and blood pressure. This information will help us assess your progress.
We will send you a kit in which you will collect a stool sample in the privacy of your home. You will return the sample in a postage-paid mailer. We will analyze your stool sample to measure the types of bacteria in your gut and analyze how it may affect your reaction to food. We will assign a clinician who will be your coach and review your test results.
You will use our smartphone app to create and track your meals every day.
You will need a continuous glucose monitor to assess your progress.
You must meet regularly with Your clinician.
We may invite You to participate in a group session.
We will collect updated health information from you during the program.
The Service will last approximately 12 weeks. At the end of the program, we will invite you to an exit visit in which you will undergo the same testing to evaluate Your success with the Service. We also will give you a brief de-identified post-pilot survey.

What are your responsibilities?
You will enjoy benefits only if you actively participate in the program.
You allow us to send you reminders for meetings, updates, etc. by email, text, or phone. We may communicate with you by telehealth, phone calls, text messages, and email. You agree that We can record video and phone sessions for quality purposes. You acknowledge that email and text messaging are not always secure forms of communication, but we will take steps to send only the minimum necessary amount of information. You may withdraw this consent any time in writing.

What are the risks?
There are no significant risks with the Pilot Program. The lab that collects your blood sample will advise you of any risks from taking blood samples. You’ll also receive additional information about the use and risks of a continuous glucose monitoring device if such a device is provided to you. You agree that our personnel can pick up and deliver to you the monitoring device from the pharmacy.

What information will you provide to us, and how will we use it?
We will collect and use only the amount of information that is the minimum necessary to provide you the Service.
You will provide Your medical and medication history, including without limitation, your insurance and medical eligibility files, claims files, and prescription files; your height, weight, and body mass index, and results from your stool samples and blood samples.
You agree that we may obtain your eligibility files, claims files, and prescription files from your health care provider or health plan to provide the Service to you.
We will keep this information confidential as detailed in our Privacy Policy
The stool samples will belong to us and will be kept in a secure laboratory under our control for validation, educational, or research purposes.
You understand that by providing any sample, you acquire no rights in any research or commercial products that may be developed by us or our collaborating partners.

Your health information is confidential.
We will not sell, exchange, transfer, or disclose your health information for marketing purposes. Only personnel authorized by Day Two, such as a lab, your dietician, Your Health Consultant, Provider or an authorized service provider may access your information solely to provide you the Service. They must abide by the same confidentiality requirements.
We take steps such as encrypting files when stored or transmitted electronically and limiting access by personnel to protect your information.
We may also be required by law to disclose information, such as in a court proceeding or investigation by the US Department of Health and Human Services.

Authorization for health care providers.
If we provide the Service are providing the Pilot Program in association with your healthcare provider, health plans or healthcare clearinghouses (your “Providers”), you authorize us to disclose the data and the results of your participation in the Service to your Provider. You have a right to revoke this authorization at any time in writing.
We may share anonymous (“de-identified”) data about your participation in the Service.
You acknowledge that we may “de-identify” you information in compliance with the safe harbor provisions of the federal Privacy Rule of the Health Insurance Portability and Accountability Act (“HIPAA”), at 45 CFR 164.514(b)(2), for the following reasons:

To share anonymous statistical data about your participation in the Service.
To provide a high-level, anonymous report to Your Provider or employer about the effectiveness and outcome of the Service.
To improve the Service for You, customize meal plans, research, and white papers and presentations.
“De-identified” data means information that would not include your name, address, email address, phone number, zip code, birth date and other information that can be used to identify a specific individual.

The Service is not a substitute for medical treatment.
You understand that We are not a “covered entity” as defined in HIPAA. Your Provider or Health Consultant may be “covered entities” under HIPAA, so the information provided to Us may be subject to HIPAA. In this case, You agree that you will obtain such authorization as necessary to your Provider to share your health information with us. To the extent we are deemed a business associate under HIPAA with your Provider, we will abide by HIPAA requirements.

Our handling of your samples.
All blood samples for the Service may be handled through a third-party physician and laboratory identified by Day Two. Your doctor may require a face-to-face session as a condition to ordering the blood sample. You will need to visit the third-party laboratory to collect Your blood sample. You may choose a physician
or laboratory other than the providers identified by Day Two, however, they may charge a fee to you or your insurance for this service. The physician and laboratory identified by Day Two has no relationship with your employer, at least for purposes of this Service. The physician who ordered your test and reviews your test may refer you to an emergency room or to follow up with your primary care physician within 24 hours if the physician determines necessary in his or her medical judgment depending on the results of your blood test.

You cannot use the Service if you do not consent to this Consent for Services form. If you do not agree, do not enroll.
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