Agreement / Signature Patient certification: By reading this information, the medical professional acknowledges that the individual/family member authorized to make decisions for the individual (collectively, the “Patient”) has received information regarding the process and consented to undergo selected testing. No test other than the specific test ordered shall be performed on the biological sample.
By eSigning this consent you agree if it is found you have insurance you will be financially responsible for all costs related to this test (approximately one hundred thirty five dollars approx.).
By eSigning this consent you agree if it’s found you have insurance you will be financially responsible for all costs related to this test (approximately One Hundred Thirty Five Dollars).
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