HumanMicrobes.org stool donor questionnaire
This form is fully secure and HIPAA compliant. HumanMicrobes.org is the only recipient of this data. However, if you choose to send the results to your own email your email provider may be able to access it. Feel free to use a secure email from a provider such as Proton.me. We may need to discuss parts of your questionnaire in our follow-up.

You should be able to verify at the bottom of this page that "This form was created inside of HumanMicrobes.org".

You could expect this questionnaire to take 15-20 minutes to complete. You will not receive a confirmation email unless you opt to receive a copy of your questionnaire. We are getting a very large number of applications so it may take more than 6 months for us to get back to you. Applying multiple times is not useful.

Important: Many people miss the follow-up email since it can land in spam. You will need to whitelist our domain (@humanmicrobes.org) to prevent that.
How-to: https://clean.email/blog/email-security/how-to-whitelist-an-email

Adding our email addresses to your contacts can help, but it is not a guaranteed method.

Before you start you may need to check with your parents about:
  • Your antibiotic history
  • Your birthing method
  • If you were breastfed, and if so, for how long
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Email *
IMPORTANT! This questionnaire's purpose is to gauge both your potential efficacy and safety as a stool donor. It is not in your best interest to be untruthful on this questionnaire. At best you would be an ineffective donor and would not be used after a few donations, or worse, you could seriously harm someone, which may result in legal action if it is determined that you lied. *
Required
I certify that the foregoing is true, correct, and complete. And if I am selected I could be asked for medical reports to confirm my statements. I understand that the accuracy, truthfulness, and completeness of my answers is important for patient safety. *
Required
Name *
Phone number (optional)
Current age *
Country (current location) *
State/region  (current location) *
City (current location) *
Zipcode (current location) *
How did you hear about us? *
If you can recall exactly where on Instagram, TikTok, etc., please specify using "other".
If you were referred by a recruiter, please provide their name or email.
Sex *
Height *
Weight *
Body fat percentage (woman) *
Captionless Image
Body fat percentage (man) *
Captionless Image
Do you play any sport? Lift weights? *
Use "Other" to specify.
Sport/exercise proficiency? *
Required
Sport/exercise frequency? *
Sport/exercise performance? *
Born via *
Breastfed? *
Blood type (if known)
Blood donor *
Occupation *
Antibiotic use (including antifungals and antivirals) *
Antibiotic frequency (including antifungals and antivirals) *
Bristol Stool Type *
Captionless Image
Required
Stool consistency *
Please use "Other" to provide further details, such as which foods cause what changes.
Required
How often do you have a bowel movement? *
Required
How often do you experience bloating or gas that will bother you? *
Diarrhea? *
Constipation? *
Upper GI *
If yes, please use "Other" to specify severity and current/past.
Required
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