INFORMED CONSENT & ASSUMPTION OF RISK:

You consent to allow Everpoint Medical PLLC and/or its laboratory partner, in conjunction with Everpoint Health, LLC (collectively, “Everpoint”)  to perform a COVID-19 active infection test and/or COVID-19 Antibody Test ("Test").  The Tests have been authorized by FDA under Emergency use Authorizations. The Test being administered may involve a nasal swab, saliva sample or blood draw that will be tested to indicate the potential presence of COVID-19 or COVID-19 antibodies.  There are some risks to having a blood test such as feeling faint or dizzy or experiencing discomfort and/or bruising at venipuncture site.  Serious complications such as infection are possible but extremely unlikely.  This test alone may not be sufficient to detect or rule out the possibility that you have been exposed to, are infected with or may become infected with COVID-19. I understand that there are risks and benefits associated with undergoing the Test and there may be a potential for false positive or false negative test results.  You should carefully monitor your own symptoms and, notwithstanding the results of any testing, you must stay home and consult with your physician if you experience symptoms of COVID-19.   

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DISCLAIMER TO TREAT:

Everpoint has been engaged for the sole limited purpose of providing a Test and disclaims any obligation to treat you or provide you with any medical care.  You have the right to discuss the Test with your own physician, to learn about the purpose, potential risks and benefits of any testing. Based upon your test results, you should contact your physician or other medical professional for advice and medical care. 

 

CONSENT TO DISCLOSE:

Because of the ongoing public-health crisis, it may be necessary for Everpoint to share the results of your Test with public health authorities.  By signing below, you consent to the disclosure of COVID Test to public health authorities as requested, recommended or required by federal, state, and local public health authorities. 

 

WAIVER OF LIABILITY & INDEMNIFICATION: 

By signing below, you, on behalf of yourself, your heirs, executors, administrators, assigns, or personal representatives and agree to forever release and waive any claim arising from your selection to receive this Test or the disclosure of your test results that may arise against Everpoint and their affiliates, managers, members, agents, staff, heirs, representatives, predecessors, successors and assigns.  Additionally, you agree to forever release and waive any claim that might arise against Everpoint and staff members for any risks, side effects, or complications resulting from the Test or the disclosure of your test results. You agree to indemnify and hold harmless Everpoint and their affiliates, managers, members, agents, staff, heirs, representatives, predecessors, successors and assigns against any and all claims, suits, or actions of any kind whatsoever for liability, damages, compensation, or otherwise brought by you or anyone on your behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by you or by anyone else acting on your behalf.