Patient Authorization and Consent to Disclose Your Test Results to Host of Sponsored Testing Event
Form Last updated: March 14, 2021
Your group testing host has hired GoLab to provide SARS-CoV-2 testing to your group as a risk-reduction safety measure. By digitally signing this consent form, you authorize GoLab to release your SARS-CoV-2 test result to the person who is paying for your testing appointment.
You are not required to consent to the release of this test record. However, if you do not consent, GoLab will be unable to perform SARS-CoV-2 testing on you as part of this sponsored group testing event.
GoLab can make no representations about how your COVID-19 test results may be used by the group testing sponsor/host after they are released to the group testing sponsor/host.
Based on the above, I certify that I have read the foregoing Informed Consent, had opportunities to ask questions, agree and accept all of the terms above, and voluntarily consent as noted above.
Print Name: ____________________________
Date and Time of Signature: ____________________