Please read the informed consent carefully.
I, authorize FOREVER YOUNG DIAGNOSTICS to conduct collection for free or Rapid COVID-19 testing througha nasopharyngeal swab. Free testing may take up to 3 business days to get the results. I acknowledge that a positive test result is an indication that I must continue to self-isolate per the current CDC guidelines to avoid infecting others. I understand that the COVID-19 testing is FREE for the uninsured under the patient care act. I understand that if I do have health insurance coverage, my COVID-19 testing will be billed to my insurance provider above or insurance provided to FOREVER YOUNG DIAGNOSTICS by the patient care act. I understand that there are no co-payments and deductibles for the COVID-19 testing since it's covered by my insurance provider. I understand that FOREVER YOUNG DIAGNOSTICS is not acting as my Primary Care Provider. Testing does not replace treatment by my medical provider. I assume complete and full responsibility to take appropriate action with regards to my test results. I agree I will seek medical advice, care and treatment from my Primary Care Provider if I have questions or concerns, or if my condition worsens. I understand that, as with any medical test, there is the potential for false positive or false negative test results.
I understand that Rapid COVID-19 testing is available for cash, debit/credit only and my insurance will NOT be billed for Rapid COVID-19 test. No refund.
I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and payment options. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask other questions at any time. I voluntarily agree to test for COVID-19.