1.Authorization and Consent for Covid-19 Diagnostic Testing: I voluntarily consent and authorize Apostle Inc, Apostle Diagnostics to conduct collection, testing, and analysis for the purposes of a COVID-19 diagnostic test. I acknowledge and understand that my COVID-19 diagnostic test will require the collection of an appropriate sample by my healthcare provider through a nasopharyngeal swab, oral swab, or other recommended collection procedures.
2.I authorize my test results to be disclosed to the county, state, or to any other governmental entity as may be required by law.
3.I acknowledge that a positive test result indicates that I must self-isolate and/or wear a mask or face covering as directed in an effort to avoid infecting others.
4.I understand the testing unit is not acting as my medical provider, this testing does not replace treatment by my medical provider, and 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.
5.I understand that, as with any medical test, there is the potential for a false positive or false negative test result. I understand that there are risks and benefits associated with undergoing a diagnostic test for COVID-19.
Release To the fullest extent permitted by law, I hereby release, discharge and hold harmless to Apostle Inc, including, without limitation, any its respective officers, directors, employees, representatives and agents from any and all claims, liability, and damages, of whatever kind or nature, arising out of or in connection with any act or omission relating to my COVID-19 diagnostic test or the disclosure of my COVID-19 test results.
I, the undersigned, have read, understand, and agreed to the statements contained within this form. I have been informed about the purpose of the COVID-19 diagnostic test, procedures to be performed, potential risks and benefits, and associated costs. I have been provided an opportunity to ask questions before proceeding with a COVID-19 diagnostic test and I understand that if I do not wish to continue with the collection, testing, or analysis of a COVID-19 diagnostic test, I may decline to receive continued services. I have read the contents of this form in its entirety and voluntarily consent to undergo diagnostic testing for COVID-19.