Please TEXT/CALL us when you are parked in our parking lot. This is the only way we will know that you have arrived for your appointment.

Due to the increased number of testing, your wait time may be up to an hour.  We will work diligently to make your wait time as short as possible. We thank you for your patience.

I consent to testing and laboratory analysis by MedPhysicals Plus, LLC. My results and the information provided by me may be reported to the ordering physician, the person or entity arranging this testing (which may include, without limitation, a current or prospective employer), any of my or their designees, and public health authorities in accordance with applicable law. My results and the information provided by me may also be used on an aggregated basis by the various certified laboratories performing the testing and analysis for internal and industry research purposes.

I consent to receiving email, text messages, and phone calls at the email address and phone number provided by me. My results may be reported to me through any of the foregoing means or any other reasonable mechanism, including web-based applications, at any time as my results are available. Any results I receive are for informational purposes only and do not constitute a medical diagnosis. It is my sole responsibility to seek and obtain medical and other advice relating t o this te sting and any results I receive.

At no cost to me, MedPhysicals Plus, LLC or the person or entity arranging this testing may contract with one or more third parties to provide certain limited physician services relating to this testing. Such se rvices may include, without limitation, evaluation of test requests, ordering of tests if appropriate, receipt of test results, and telemedicine consultations (c ollectively, "Physician Services"). The Physician Services will not include treatment or pres cription services. It is my sole responsibility to follow up with my healthcare provider for treatment or prescription services. I agree to the Physician Services to the extent they are made available, and I consent to my information and results being shared with providers of the Physician Services.

I understand that there are possible risks associated with blood draws and nasopharyngeal swab specimen collection, including, without limitation, infection, discomfort, and bruising. I understand these risks may not be all-inclusive and that other more remote risks may be involved. However, this notice is sufficient for me to consent to and authorize the collection of a blood, saliva or nasopharyngeal swab specimen.

I understand that this testing is voluntary. As with all laboratory tests, there is a chance of a false positive or false negative result. By clicking "I Accept" below, I am agreeing to all of the terms of this Notice, Consent, and Release for COVID-19 Testing. If I do not agree with any of these terms, I will not click "I Accept", and I will not be able to receive these testing services.

To the fullest extent permitted by law, I release and forever discharge MedPhysicals Plus, LLC and the laboratories they employ to perform the testing and analysis and the person or entity arranging this testing from liability relating to the Physician Services and the collection, testing, and reporting of information described herein.

MedPhysicals Plus, LLC requires payment at the time of service and by signing below I agree that I am financially responsible for all services I may acquire from my visit(s). I acknowldge that MedPhysicals Plus does not bill any health insurances.

I am at least 18 years of age or the legal guardian of the donor with authority to consent on their behalf. I AGREE TO ALL OF THE TERMS OF THIS NOTICE, CONSENT AND RELEASE FOR COVID-19 TESTING.

DEPT. OF HEALTH REPORTING- Information Required for Infectious Disease 

I understand that a detected/positive test DOES NOT mean that I am immune to COVID-19 and that I will never catch the virus again.

In consideration for such services being rendered on my behalf, I hereby RELEASE MPP, its officers, agents, and employees, from any and all claims which I might otherwise have due to such results being made so available. I hereby CONSENT NOT TO FILE ANY ACTION at law or in equity against company connection with the results of such screen being made so available, and I herby agree to INDEMNIFY and SAVE HARMLESS MedPhysicals Plus, LLC, the laboratory testing service, their respective officers, agents, and employees from all damages, expenses, reasonable attorney's fees, and costs of court which they or any of them may suffer or incur, jointly or severally, due to the results of such screen being made so available.

By signing this form, I acknowledge that MPP is a medical laboratory testing service and not a physician's office. Therefore, MPP does not provide diagnosis, diagnosis codes to insurance, or medical treatment of any kind. I acknowledge that without diagnosis code from my physician, my insurance may or may not reimburse me for the cost of the test done.

AUTHORIZATION TO DISCLOSE PROTECTED LAB RESULT

I authorize MedPhysicals Plus, LLC to release/disclose my COVID-19 test result to the employer/third party I listed on this form; who may or may not be responsible for paying for the services today.

Please only select a service item from below if  YOU are responsible for your payment.

DO NOT select any services below if your Employer is paying for the service today.  You will be required to enter a credit card if you make a service selection below.

You will receive a confirmation email with a receipt and a copy of the form you filled out.  A separate email is generated with a password to open the form.   Thank you and take care!