OUR TERMS AND CONDITONS|CONSENT FORM
Clinical Sticks is an independent concierge service and Patient Service Center that collects specimens from patients at the convenience of their chosen locations.
1. I understand that it is my responsibility to consult with a physician/health care provider prior to and regarding my participation in any medical treatment including blood draws and medical testing I may engage in.
2. In consideration of being permitted to participate in any services offered by Clinical Sticks and its affiliates, I knowingly, voluntarily and expressly waive any claim I may have against the healthcare professionals providing the services, owners, students, volunteers, administrators, affiliates or insurers for injury or damages that I may sustain as a result of participation. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue the healthcare professionals individually or as part of Clinical Sticks that are providing phlebotomy and/or medical laboratory services. As well as owners, volunteers, administrators or insurers for any injury or death caused by their negligence or other acts.
3. I understand the inherent risks involved with the phlebotomy and/or medical testing services I may undergo, and I still choose to go forward with said services. These services include all but are not limited to those provided by the healthcare professional, students and volunteers of Clinical Sticks.
4. I understand that Clinical Sticks is a mobile phlebotomy and medical testing concierge service. Clinical Sticks is an independent concierge service and Patient Service Center that collects a specimen from you, the patient, and delivers the specimen to the laboratory. Clinical Sticks is not a laboratory or a medical practice. Clinical Sticks is available for collection of specimens and handling with laboratories.
5. I understand that these services offered by Clinical Sticks do not establish a patient-provider relationship. I further understand that any and all communications are for the collection of information needed for services rendered. I understand that I will not be provided with any medical advice, diagnosis, treatment plan, or recommendation. I understand, I am to follow up with my healthcare provider for any medical advice, treatment or diagnosis.
6. I understand that Clinical Sticks is not responsible for any errors that may occur at the laboratory. I understand that the laboratory is solely responsible to process the collected specimen once received by Clinical Sticks. In the event of a lab error, Clinical Sticks
will return to recollect the sample at a discounted rate, at the written request of the patient. Any error made by Clinical Sticks will be corrected at no extra charge; so long as all documentation was submitted adequately prior to appointment.
7. Laboratories may bill your insurance company directly for the testing of the collected specimen. Any billing questions or issues for tests collected for this service should be directed to your insurance company or the laboratory billing department.
8. Any payment received by Clinical Sticks is for the purpose of the collection of specimens and/or for the testing of said specimen. In the event you are uninsured, Clinical Sticks will collect payment for testing from you directly. In the event that you engage in services not covered by insurance, Clinical Sticks will bill you directly for testing.
9. Payment for services provided by Clinical Sticks is collected at least 24 hours prior to appointment. Clinical Sticks will not bill insurance companies, any claims must be submitted by the client, with no guarantee of reimbursement. Patients should be aware that while insurance will cover the cost of the laboratory test, it does not cover Clinical Sticks cost of collecting the specimen, handling and transportation.
10. Please be advised that Clinical Sticks is not responsible for any outstanding balances with the designated performing laboratory and will need to be settled prior to a scheduled home lab draw. The laboratories have the right to decline specimens of patients with outstanding balances. If your testing is declined due to outstanding balances owed to the laboratory, Clinical Sticks will not reimburse any services performed.
11. Clinical Sticks is an independent mobile concierge phlebotomy service and Patient Service Center. Clinical Sticks is not affiliated with any laboratories or doctor’s offices. We do not have the authorization to deal with any payments to the laboratory.
12. Clinical Sticks will make a good faith effort to handle the specimen collected and bring it to the laboratory drop off within a reasonable time frame. Any estimated time period for lab results shall begin at the time the specimen is acquired by the laboratory and not any earlier.
13. Under no circumstances will Clinical Sticks give out clients’ personal information to unauthorized personnel. All patient information is always kept confidential.
14. Your results will be emailed to you directly from Clinical Sticks. Please note that emailed results are not sent via encrypted email. Any results for minors under the age of 18 will be sent to the email address for the parent or guardian provided.
15. In accordance with Louisiana State law the laboratory will report all findings for the following tests to the Louisiana State Department of Health and Mental Hygiene: COVID-19, and any other tests required by law. A copy of all results may also be sent to your primary care physician.
16. In the event that you need to cancel an appointment Clinical Sticks requires at least 24-hour written notice. All cancellations less than 24-hours prior to the scheduled appointment will be charged the full amount for services.
17. I have read the above release and waiver of liability and fully understand its contents. I hereby waive my rights to bring any claims against Clinical Sticks. I voluntarily agree to the terms and conditions stated above.