I authorize specimen collection with a saliva tube, a nasopharyngeal swab, a nasal swab and/or collection of blood through a finger venipuncture for SARS-CoV2, the virus that causes COVID-19. I further understand, agree, certify, and authorize the following:

  1. I authorize TDS Labs LLC to collect the specimen.
  2. I have the right to refuse testing.
  3. The saliva test utilizes a saliva collection kit to collect, store and transport saliva samples for PCR testing.
  4. The nasopharyngeal swab test utilizes a swab (like a Q-Tip, but smaller) slid into the nostril to obtain a sample from the back of the top of the throat called the Nasopharynx. A larger swab may be used to collect a specimen from inside the nose. It 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 these types of swabs.  I acknowledge that the nature of the collection will cause slight discomfort.
  5. I understand that risks and complications of the finger puncture include: pain at the puncture site, bruising, I may become lightheaded, inflammation at the puncture site and rare risk of infection.
  6. I authorize TDS Labs LLC to perform testing on my specimen.
  7. I understand that processing of the specimen and results may be available on the same day, however, in certain circumstances, if the specimen is received after the cutoff time or if the initial results are invalid, test results may take 24-48 hours.
  8. TDS Labs LLC will send a validation link with the test results to the mobile number used during registration. I authorize TDS Labs LLC to release test results or other information necessary to the ordering medical provider and to me.
  9. I have received the “Fact Sheet for Patients regarding the Molecular Laboratory Developed Test (LDT) COVID-19 Authorized Tests”, as required by FDA.
  10. I understand that TDS Labs LLC has infectious disease reporting responsibilities under applicable governmental regulations and will report my testing information in accordance with these regulations.
  11. I understand that I am not entering into a doctor-patient relationship with TDS Labs LLC or Dr. Michael Bauer, MD and that any questions or required follow up shall be my responsibility to arrange with my own physician.

By digitally accepting this agreement upon registration and continuing with the specimen collection, I acknowledge that I have read, understand, agree, certify and authorize the information above and further agree that myself and my heirs, executors and assigns hereby release TDS Labs LLC and its employees, agents and contractors from any and all liability and claims.