At the time you order a test, you will be asked to sign the following Consent and Disclaimer.
I have requested the specific laboratory test(s) listed above.
Laboratory results from Cinch® are for informational purposes only and are not a substitute for medical advice, diagnosis or treatment.
I am aware that I should consult a physician/healthcare provider before I stop, start or change any treatment plan, including the use of medication.
I am responsible for consulting a physician/healthcare provider.
Neither Cinch®, nor its employees, will interpret the results for me.
I understand that results within the reference (normal) range do not ensure health.
I understand that results that fall outside the reference range may not indicate disease.
I understand that lab tests are not a substitute for a full medical evaluation.
I understand that reactive (positive) results to Hepatitis A, Hepatitis B or GC/Chlamydia must be reported to my local County Health Department according to specific regulations.
I will not hold Cinch®, its Officers, Directors and employees, its affiliates, program sponsors and agents, including the owners/operators of this facility, or its parent companies, their Officers, Directors and employees liable for any outcomes which may result from my participation in this testing option.
If I have requested that my results be mailed to me, I retain all responsibility should someone else at that address access these results. I have also provided a phone number at which I can be reached in the event that critical values are reported.
I understand that I am expected to pay Cinch® in full at the time of service and that no other billing will occur. If I am eligible to receive Medicare benefits, I am aware that Medicare does not cover this service and I am fully responsible for payment at this time.
I understand that a copy of the Summary Notice of Privacy Practices and the entire Notice of Privacy Practices is available should I request it.
If the results show I have HIV, I acknowledge that I will pursue contact with a healthcare provider, public health clinic or AIDS information organization for further information on additional testing or treatment options. I acknowledge that I have had the opportunity to review information with the following details about HIV testing: