• Luminnova Health CoVID-19 Home Treatment Program

    Online Consent Form
  • Birth Date
     - -
  • Format: (000) 000-0000.

  • CovidCare Physician

  • My CovidCare Physician
  • I understand that the online questionnaire responses and consent document will be sent to my selected Covidcare Physician and Luminnova Health

  • Informed Consent

  • Please CLICK HERE to review the Luminnova Health CoVID-19 Home Treatment CONSENT FORM.

     

    Kindly read the form CAREFULLY and feel free to contact the Luminnova Health team if you have any questions or concerns. 

     

     

  • I confirm that I have read and understood the Consent Form in its entirety and have had an opportunity to clarify any outstanding questions
  • I understand that while timely and proper use of the Covidcare System reduces the risk of CoVID-19 infection, it does not guarantee that infection will not occur.
  • I understand that in the event that I have close contact with someone someone who is CoVID-19 positive, or if I have tested positive or have CoVID-19 symptoms, I should contact my CovidCare physician immediately for further advice and treatment.
  • Should be Empty: