Insurance Information

Informed Consent for COVID-19 Testing
Please carefully read the following informed consent:
A ➝ I authorize this COVID-19 testing unit to conduct collection and testing for COVID-19 through a nas pharyngeal swab, as ordered by an authorized medical provider or public health official.
B ➝ I authorize my test results to be disclosed to the county, state, or to any other governmental entity as may be required by law.
C ➝ I acknowledge that a positive test result is an indication that I must continue to self-isolate in an effort to avoid infecting others.
D ➝ I understand that I am not creating a patient relationship with THE WELLNESS LOUNGE by participating in testing. I understand the testing unit is not acting as my medical provider. Testing does not replace treatment by my medical provider. I assume complete and full responsibility to take appropriate
action with regards to my test results. I agree I will seek medical advice, care and treatment from my medical provider if I have questions or concerns, or if my condition worsens.
E ➝ I understand that, as with any medical test, there is the potential for false positive or false negative test results.
F ➝ I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask other questions at any time. I voluntarily agree to testing for COVID-19.