Please read the following document carefully and sign:
a. I authorize this Covid-19 Test Center "Family Rehab" to acquire a nasopharyngeal sample and to examine the sample for the detection of Covid-19 as required by public health agencies.
b. I authorize my results to be communicated to any government agency or as required by law. I also authorize the communication of my positive results to airlines and cruise ships as required by Miami-Dade County Government. This authorization is valid for a period of one (1) year from the day it was signed.
c. I understand that a positive result is an indication that I should quarantine, wear a mask or cover my face so as not to infect others
d. I understand that this laboratory is not acting as my physician, and does not replace the need for a physicians care when required. I also accept responsibility for my results and what they mean. I agree to obtain a medical consultation with my physician to clarify any concerns I have, to obtain care / treatment if my condition worsens and I understand that like other diagnostic procedures, there is a possibility of a false positive or false negative test for Covid-19.
e. I understand that "Family Rehab" are in no way responsible if the client / patient does not arrive on time for their flight / misses it or is quarantined upon arrival at their destination. I understand that the responsibility for choosing the type of proof necessary for my destiny is mine and mine alone.
f. I understand that "Family Rehab" are in no way responsible if the client / patient does not arrive on time for their flight / misses it or is quarantined upon arrival at their destination. I understand that the responsibility to choose the type of test necessary for my destiny is mine and mine alone.
g. I understand and agree that "Family Rehab" do not provide cancellations or refunds once the test has been administered.I, the patient / client, have been informed of the purpose of the test, the procedures, the possible benefits and risks. I have also received a copy of this consent. I have been given the opportunity to ask questions before signing. I accept this Covid-19 test voluntarily, for my personal, business or travel needs
I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this Informed Consent. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask additional questions at any time. I voluntarily agree to this testing for COVID-19.
Cough (new onset or worsening of chronic cough) *
Difficulty breathing (dyspnea)*
Abdominal pain *
Muscle aches (myalgia)*
Runny nose (rhinorrhea) *
Diarrhea (3 loose stools / day) *
Loss of smell *
Loss of taste*
Select the test*