485 S. Fairfax Ave, Los Angeles, CA 90036


    Please carefully read and sign the following Informed Consent:
    • a. I authorize LA Health Test Inc. to conduct collection and testing for COVID-19 through a nasopharyngeal swab or oropharyngeal swab.
    • b. I authorize my test results to be disclosed to the county, state, or to any other governmental entity as may be required by law.
    • c. I acknowledge that a positive test result is an indication that I must self-isolate and wear a face covering as directed in an effort to avoid infecting others in accordance with CDC guidelines. It is my responsibility to follow these guidelines.
    • d. I understand that LA Health Test Inc. is not acting as my medical provider, this testing does not replace treatment by my medical provider, and I assume complete and full responsibility to take appropriate action with regards to my test results. I agree that I will seek medical advice, care and treatment from my medical provider if I have any questions or concerns, or if my condition worsens.
    • e. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID19 test result.

    I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of the 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. I agree to release and waive any claim that might arise against LA Health Test Inc. and its designated health providers and staff members for any risks, side effects or complications from testing.