Personal Information Privacy and Use of Results of Public Health and Medical Professionals:

I understand and authorize Hero Lab to report the result of by test to ____________ (employer or principal) and the Department of Health (DOH), to the local government and other government agencies or instrumentalities as mandated by law. The purpose of this need to know sharing of my results is for the limited purpose of informing medical providers so they may advise me on appropriate medical treatment and for limiting the spread of communicable diseases.

I understand the inherent risk of any medical test associated with test and I hereby voluntarily agree to have my sample collected and analyze by Hero Lab and waived any and all rights, claims, or causes of action of any kind whatsoever from my participation in this activity, and do hereby release and forever discharge Hero Lab, including its officers, directors, employees, agents and representatives from any physical or psychological injury, including but not limited to illness, paralysis, death, economical loss, that I may suffer as a direct result of my participation in this activity, including travelling to and from any location related to this activity. I the event that I should require medical care treatment, I agree to be financially responsible for any costs incurred as a result of such treatment.

By checking the Check Box mean I signed this Informed Consent Form and I declare that:*

I, the undersigned, have been informed about the purpose of the test, procedures, possible benefits and risks, and I have received a copy of this Informed Consent which is written in a language, I know, speak and understand. 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 the COVID-19.