I authorize specimen collection with a nasopharyngeal swab, nasal swab, saliva, urine and/or collection of blood through venipuncture for testing. I further understand, agree, certify, and authorize the following:

  1. I understand that MyHomeLabs, has contracted with [COLLECTION SERVICE] for collection of my specimen. I authorize [COLLECTION SERVICE] to collect the specimen.
  2. I have the right to refuse testing. In the event you refuse testing MyHomeLabs will not make any full refunds. It will be at MyHomeLabs’s discretion to decide if a refund is issued including the refund amount.
  3. All specimen collection methods may be uncomfortable, painful, or potentially cause mild abrasion or bleeding. No long-lasting side effects from testing are expected. I understand that there is minimal risk with collection of a specimen with a nasal swab. I acknowledge that the nature of the collection will cause slight discomfort.
  4. I understand that Risks and Complications of the blood draw include: Pain at the draw entry and at draw site, bruising, may become lightheaded, inflammation of the vein, rare risk of infection and rare risk of nerve or tendon injury.
  5. MyHomeLabs has contracted with CLIA compliant laboratories for laboratory analysis and report of my specimen. I authorize CLIA compliant laboratories to perform testing on my specimen. A list of CLIA complaint laboratories can be requested by emailing MyHomeLabs customer services.
  6. I understand that processing of the specimen and results may take between 5 to 7 days.
  7.  I authorize CLIA-compliant laboratories to release test results or other information necessary to MyHomeLabs and to me.
  8. I understand that MyHomeLabs has infectious disease reporting responsibilities under applicable governmental regulations and will report my testing information in accordance with these regulations.
  9. I agree that none of the tests offered by MyHomeLabs are intended to diagnose any condition. Only a healthcare provider can make that determination. I also understand and agree that none of the tests can be a substitute for seeking professional medical advice, help, diagnosis, or treatment.
  10. I understand that all tests purchased by me through MyHomeLabs are ordered by a licensed healthcare professional authorized to order laboratory testing in accordance with state laws.
  11. I understand that at the time I order the test, I’m 18 years and older. I understand that if I am under the age of 18,  permission from a  legal guardian is required.
    1. As legal guardian, you agree you are 18 years of age or older and are voluntarily requesting services on your minor’s behalf. You also understand that by requesting testing on your minor’s behalf, you agree to all terms and conditions of MyHomeLabs, and you understand and agree to the testing consent on your behalf and your minor’s behalf.
  12. I understand that I am not entering into a doctor-patient relationship with MyHomeLabs, [Ordering Physician group], or Authorizing MD, and that any questions or required follow up shall be my responsibility to arrange with my own physician.

By clicking I agree, I acknowledge that I have read, understand, agree, certify, and/or authorize the information above and further agree that I and my heirs, executors and assigns hereby release, MyHomeLabs, CLIA compliant laboratories, [Ordering Physician group], and [COLLECTION SERVICE], including its employees, agents, and contractors from any and all liability and claims.