BIOREACH’S INFORMED CONSENT
Effective Date: 06/30/2023
I, as the individual (or his or her legal representative) receiving services, agree to receive the services provided by Bioreach Laboratories, LLC, hereinafter referred to as (“we” “us” or “Bioreach”) or its business services provider Eyght, LLC. I agree that the services may include customer support or counseling, educational resources, and any other related services provided by Bioreach, such as ordering laboratory tests (“Tests”), including, without limitation, physician oversight, for the ordering of Tests, the results of the Tests, the (“Results”)and any other related services provided by Bioreach directly or through its business services provider, Eyght, LLC, (the “Services”).
I acknowledge and agree to the following:
- I have read, understand, and had the opportunity to ask questions about the information provided about Bioreach’s Services.
- My medical history is correct to the best of my knowledge. I will hold neither Bioreach nor Eyght, LLC, its business partners, or employees responsible for any errors or omissions that I may have made in providing such information.
- (“Health Care Providers”) means Bioreach, its partners, and employees.
- I authorize Bioreach and third-party business services provider Eyght, LLC, Health Care Providers, staff, and agents to view and use my health information, including any Test Results in furtherance of its healthcare operations.
- Only physicians diagnose conditions, disease, or illness.
- If I receive an abnormal Result on a Test I understand that a member of Bioreach’s will not attempt to call me to review the Results, nor offer education, nor explain the next steps I should take. If I do receive an abnormal Result, I understand that I should not delay following up with my primary physician. I am responsible for initiating follow-up care with my physician. I will let Bioreach’s team know of my desire to have my information forwarded to my primary care or other personal physician, and I will fill out the required release form.
- I will not make medical decisions without consulting a health care provider or disregard medical advice from my health care provider or delay seeking such advice based on information I receive as a result from a test.
- I have the right to withdraw my consent to use shared access to medical records in the course of my use of service at any time by contacting Bioreach’s team by calling 1-888-987-3220 or emailing email@example.com.
- My health and wellness information pertaining to services are governed by Bioreach’s Notice of Privacy Practices.
- I may need to see a health care provider in person for diagnosis, treatment and care.
- There are potential risks associated with the use of technology that are beyond Bioreach’s and any health care provider’s control, including disruptions, loss of data, and technical difficulties.
- There are alternative services available to me if I experience medical symptoms that require immediate attention, such as visiting a primary care provider, an emergency room, or an urgent care facility; however, I voluntarily choose to proceed with Bioreach’s Services at this time.
- I understand that if I have any questions before or after my Test, I can contact Bioreach’s team by calling 1-888-987-3220 or firstname.lastname@example.org.
- I authorize Bioreach to use the email address and phone number I provided in connection with my account and to contact me in connection with the Services. I am responsible for contacting Bioreach’s team by calling 1-888-987-3220 or email@example.com to notify them of any changes to my mailing address, email address, phone number, medical history or other information that I provided in connection with the Services.
- I have read this Informed Consent carefully, and all my questions were answered to my satisfaction. I hereby consent to receive Services from Bioreach pursuant to the terms, conditions, standards, and requirements set forth herein.