• Kit Registration

  • Date of Birth *
     - -

  • HEALTH HISTORY

  • Biological Sex*
  • Are you currently pregnant?*
  • Do you currently have any of the following symptoms? e.g., itching, discharge, sores, pain*
  • When did the symptoms begin?
     - -
  • Have you noticed any rashes or lesions in your genital or anal area?*
  • Do you have any pain during urination or intercourse?*
  • Have you recently experienced flu-like symptoms (e.g., fever, body aches)?*
  • What types of sexual contact do you engage in?*
  • Do you use condoms or other barrier protection?*
  • Have you ever been diagnosed with a Sexually Transmitted Infection (STI)?*
  • Have you been tested for HIV?*

  • HIPAA Data Release Consent

  • At Got Lucky Labs, we are committed to protecting your personal health information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This notice describes how your medical information may be used and disclosed, and how you can access this information.

    We may use your health data to provide testing services, share results with our partner laboratories or authorized healthcare professionals, and comply with legal or public health obligations. We do not sell your personal data. You have the right to request a copy of your records, limit certain disclosures, and revoke your consent at any time. To review the full details of your privacy rights and our responsibilities, please refer to our complete Notice of Privacy Practices or contact us at privacy@gotluckylabs.com.

  • Consent for services, testing, and privacy policy

  • I have received and acknowledge the [Privacy Practices].
    I understand and consent to the testing process, its risks, and my rights.
    I consent to receive services, including remote Telehealth care where applicable.
    I may revoke this consent at any time by contacting privacy@gotluckylabs.com

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