Terms & Conditions
By signing this document I understand that this procedure is only covered by my insurance if testing is required as a medical necessity. Carecube providers can assess the need for testing on a case to case basis, though may not grant testing if I do not meet certain criteria issued by CDC.
By signing here I also agree the above information is accurate to the best of my knowledge and are consenting to receive the Covid-19 antibody and/or antigen swab test. If I do not provide my insurance information or my insurance does not cover testing, I will be billed by CareCube upfront for the services provided and agree to pay $125 for swab/antigen test and/or $75 for antibody test.
I give permission for CareCube to send my COVID-19 results to the email provided on this form. I understand that this email is encrypted but once it has landed in my inbox Carecube is not responsible for breaches of confidentiality that may occur once this consent is signed. By signing this consent, I also
confirm that I am the person of which the information in this form pertains to and I am not falsifying my identity, information or intent.
By Signing this document I confirm that I have liaised with my airline, school
or place of work personally and are getting the correct test today for the reasons of which I require it.If your reason for testing today does not fall under a medical necessity category such as: you have experienced symptoms for longer than 5 days, you have been exposed to a person infected with the virus,you are an essential worker, this is considered non essential and is not an emergency.
As such, CareCube advises you to see our Nurse Practitioner for an assessment, specimen collection and for your specimen to be sent to a lab for processing, the results take 3-5 days minimum to return.This is what is medically advised to you under best practice and the process will be covered by your insurance and your copayment waived.It is within your rights to refuse this advice. If you choose to refuse you will be charged out of network fees to take the rapid testing upon your own request and against CareCubes medical advice.
By signing this waiver you acknowledge that contradicting medical advice means you were charged for testing upon your insistence to receive rapid testing.By signing this waiver you agree no further action will be taken against CareCube because of the actions you took in opposition to the medical advice given to you, and you will not be entitled to any reimbursement surrounding covid testing. You also confirm that you are the person of which the information below pertains to and you are not falsifying your identity, information or intent.