INFORMED CONSENT FOR RAPID COVID-19 ANTIBODY and ANTIGEN TEST

Please read the informed consent carefully.

The following has been explained to me, and I agree:

I will have a rapid Covid-19 test performed at CHOICE 4U LAB SERVICES LLC.

A positive test is considered diagnostic, and a confirmatory testing will be performed

to Lab for confirmatory testing. This may take several days to result. I will be notified by phone,

text, or email when my confirmatory test results are received.

In case I don't get notified within 72 hrs., I will call CHOICE 4U LAB SERVICES LLC at 317-622-6068

for my confirmatory test result.

By law, the Indiana Department of State Health Services will be notified that I was tested,

and what the test results are.

In addition, I have been shown a copy of the instructions of what I have to do

following testing, I have read those discharge instructions thoroughly, and I

Agree to comply with those instructions. I agree to self-quarantine until I am cleared.

I acknowledge and understand that my COVID-19 diagnostic test will require the collection of an

appropriate sample by my healthcare provider through a nasopharyngeal swab, as the recommended collection procedures.

I understand that there are risks and benefits associated with undergoing a diagnostic test for

COVID-19 and as with any medical test, there may be a potential for false positive or false negative test results.

I assume complete and full responsibility to take appropriate action with regards to my test

results. Should I have question or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider.

I understand that Rapid COVID-19 testing is available for cash/card pay only and my insurance

will NOT be billed for Rapid COVID test.