I hereby grant permission to ARCpoint Labs to perform testing or specimen collection for the purpose of conducting certain screening test(s), which may require venipuncture, finger stick, nasal swab or oral fluid collection, as set forth above at my direction. I understand that the actual testing may be performed by ARCpoint Labs or a third-party laboratory.
I understand that the tests requested are for my own use and not for medical diagnostic or treatment purposes. I agree that I am personally financially responsible for payment of fees for all tests ordered and collected by ARCpoint Labs at my request, and I agree will not seek to be reimbursed by Medicare, Medicaid or any other government insurer/payor for the test(s) performed.
I understand that test results reported by ARCpoint Labs will be reported directly to me in the manner I have chosen above, and I understand that it is my sole responsibility to consult my own medical professional for the interpretation, analysis, evaluation, and explanation of my test results in my discretion.
I understand that if testing returns critical values which may indicate a serious medical condition, ARCpoint Labs or a representative thereof will make reasonable attempts to notify me promptly, including by telephone and/or email. I also understand that it is my responsibility to ensure that my contact information is accurate and to notify ARCpoint Labs of any changes.
I agree that ARCpoint Labs, directors, staff, physicians, and/or any agent or employees thereof (“ARCpoint”) shall not be liable for any claim arising out of or related to the Services, including but not limited to, inaccurate, un-interpreted, misinterpreted results or results not received and do hereby expressly forever release and discharge ARCpoint from such claims, demands, injuries, damage, or causes of action.
I HEREBY CERTIFY THAT I HAVE READ THE ABOVE ACKNOWLEDGEMENT AND HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS ABOUT ITS CONTENTS. BY SIGNING BELOW, I CONSENT TO UNDERGO THE COLLECTION AND LABORATORY TESTING UNDER THE CONDITIONS SET FORTH HEREIN.