I have read, understand, and agree to the testing service disclosures regarding to be rendered and provide my consent to receive such services.

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By Signing Below... I consent to review my test results via text or personal email and to communicate with Covid Clinic via text or email. I understand that communications via text and email may be unsecured and have a greater risk of disclosure. I confirm I am the patient or have the authority to sign on behalf of the patient. If you are signing on behalf of a minor, by signing below you are representing that you are authorized to consent to the administration of the testing services on behalf of the minor. In order for your PCR test to be billed to your insurance provider or the government/HRSA, an order from a licensed provider is required. Covid Clinic will accept an order from any licensed provider. However, if you do not have an order you consent to a telehealth consultation with a provider from Driven Care. This consultation will be billed to your insurance or HRSA (for uninsured patients) by Driven Care and you consent to Covid Clinic sharing your insurance information with Driven Care for these purposes.