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PATIENT SIGNATURE:

For non-touch screen devices, the patient needs to type their full name below, and provide a secondary identifier.

By selecting the Add Signature button, I attest that I approve of this digital signature

Axis Laboratory Services will perform PCR (polymerase chain reaction) Covid-19 testing for   starting on . When obtaining a COVID-19 test, I will manually enter my information into a HIPAA secure online portal including, but not limited to, my full name, date of birth, address, and insurance information. I will be supplied with a specific URL and/or QR code that links me directly to the online portal. Read more
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