By signing this form, I agree to the following:
a. I authorize this COVID-19 testing unit to conduct collection and testing for COVID-19 through a nasopharyngeal swab (a swab in the nose) or an oral swab (a swab in the throat).
b. I authorize my test results to be disclosed to the Florida Covid19 Reporting Portal.
c. I acknowledge that a positive test result is an indication that I should self-isolate and wear a mask or face covering as directed.
d. I understand the Family Care Pharmacy is not acting as my c medical provider, this testing does not replace treatment by my medical provider, and I assume complete and full responsibility to take appropriate action when I receive my test results. I agree I will seek medical advice, care and treatment from my medical provider if I have questions or concerns, or if my condition worsens.
e. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.
f. I understand that there will be a $99.00 charge for this test payable over the phone at 813-659-9777. Calling hours are 9am to 6pm Monday to Friday only.
I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this Informed Consent and the Notice of Privacy Practices.
When you arrive for your appointment please park on the West side of our building by our electronic billboard street sign. There are 2 curbside spaces where we will perform your test carside.
Please call us prior to your test at 813-659-9777 to pay via credit card over the phone to secure this appointment.