driplife iv
Hydrating A World Thirsty For Wellness

Covid Testing Waiver


Patient Information:

    Please carefully read the following informed consent:

    • I authorize Deacon Medical Corp. dba DripLife IV and the licensed healthcare providers contracted by Deacon Medical Corp. to conduct collection and PCR testing for COVID-19 through a nasopharyngeal swab.
    • I authorize my test results to be disclosed to the country, state, or to any governmental entity as may be required by law.
    • 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.
    • I understand that I am not creating a patient relationship with Deacon Medical Corp. by participating in testing. I understand Deacon Medical Corp. is not acting as my medical provider. Testing does not replace treatment by my medical provider. 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.
    • I understand that, as with any medical test, there is the potential for a false positive or false negative test result with the COVID-19 test.
    • I acknowledge that I have been given a copy of Deacon Medical Corp.’s Notice of Privacy Practices.

    I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this informed consent. I have been given the opportunity to ask questions before I sign, and I 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 Deacon Medical Corp. dba DripLife IV and its designated health care providers and staff members for any risks, side effects or complications from testing.