If you are experiencing severe symptoms, please contact your health care provider. If you are experiencing a life-threatening emergency, please call 911 immediately.
I authorize Molecular Matrix, Inc. Diagnostic Laboratory (Molecular Matrix) to collect a specimen from me (or my child/dependent named in the Test Requisition) for COVID-19 testing in accordance with the Terms and Conditions.
I understand that individuals aged 13 and up are authorized to perform the self-swab specimen collection procedure and individuals aged 12 and under require a parent/legal guardian to perform the swab specimen collection. Minors must be accompanied by a parent/legal guardian during the test procedure.
I understand, acknowledge, and accept that I (or my child/dependent) may experience discomfort or other negative reaction as a part of or result of the Covid-19 Testing Service. This discomfort or other negative reaction is inherent to the testing process.
I understand, acknowledge, and accept that Molecular Matrix may use email, voicemail, or text message to transmit my test results to me, and I understand the potential risks that may arise.
I understand, acknowledge, and accept that Molecular Matrix, Inc. is required to disclose test results to local, state, and/or federal health departments pursuant to applicable laws and regulations.
I understand that I should contact my healthcare provider to discuss the outcomes of this test.
By my signature below, I acknowledge that I have read, understand, and accept the statements above and the Terms and Conditions.