I am a consumer seeking a COVID-19 test. The sample being tested by Clarity Laboratories, LLC (“Clarity”) will be collected by a third-party through a nasal swab. As evidenced by my acceptance indicated below, I acknowledge and agree as follows:
I am voluntarily signing this Consent Form to authorize the Clarity perform testing on a sample collected by a third-party.
I expressly acknowledge and agree that, as with any medical test, there is the potential for false positive or false negative test results.
I acknowledge and agree that the results of this test, either positive or negative, should not be used as the sole basis for treatment or non-treatment for COVID-19.
I acknowledge that a positive test result is an indication that I should self-isolate in an effort to avoid infecting others.
I authorize my test results and demographic information to be disclosed to any county, state, or to other governmental entity as may be required by law, including, without limitation, the New Jersey Department of Health, and the Centers for Disease Control.
I understand and acknowledge that there are potential complications that may result from the collection of the sample. I agree to forever release, waive, hold harmless, indemnify, and discharge the Clarity and its present or former officials, principals, employees, independent contractors, agents, attorneys, insurers and representatives and their respective successors, heirs and assigns or any volunteers from any and all liability, damages, losses, claims, actions, demands, expenses, attorneys’ fees, breach of contract actions, breach of statutory duty or other duty of care actions, warranty actions, strict liability actions, malpractice actions, tort actions, and any other cause of action whatsoever that I now have or I might have in the future arising out, of or related to, any loss, damage, or injury, including, without limitation, death, or the development, deterioration, or worsened prognosis of any medical condition or disorder I may have, including, with specificity, COVID-19, that I may sustain as a direct or indirect result of the testing services provided to me by the Clarity.
I hereby waive any claim in law or equity for redress of any grievance that I may have concerning or resulting from the test by Clarity.
I understand that I am not creating a patient relationship with Clarity by participating in testing. I understand that Clarity is not acting as my medical provider, and that the performance of the COVID-19 test does not replace treatment by my medical provider.
I assume complete and full responsibility to take appropriate action with regards to my test results, and that I will seek medical advice, care and treatment from my medical provider.
By agreeing below, I acknowledge that I have read and understand the above information. I have been informed about the sample gathering technique, the test, procedures, possible benefits and risks. I have been given the opportunity to ask questions and that all of my questions have been answered to my satisfaction. I voluntarily agree to testing for COVID-19.