Further, I hereby given my consent:
To the healthcare provider of G & R Health Mart Pharmacy, as applicable (each an "applicable Provider"), to administer the COVID-19 test(s) I have requested above. I understand that it is not possible to predict all possible side effects or complications associated with receiving a COVID-19 test(s). I understand the risks and benefits associated with the above COVID-19 test(s) and have received, read, and/or had explained to me the information pertaining to the COVID test(s) I have selected and all of my questions have been answered by a G & R Helath Mart Pharmacy staff member to my satisfaction. On behalf of myself, my heirs and personal representatives, I hereby release and hold harmless the applicable Provider, its staff, agents, successors, divisions, affiliates, subsidiaries, officers, directors, contractors and employees from any and all liabilities or claims whether known or unknown arising out of, in connection with, or in any way related to the administration of the COVID test(s) listed above. For travel purpose we will provide Rapid Antigen Test form with results. If you require specific/special documents you will be responsible to find out if our document will be accepted. We Do Not Perform PCR Test.