COVID Tests

I represent that I am ordering the Tests for personal use, and not for employment purpose or for resale or donation to others. I have not ordered similar or the same tests this month from any other healthcare provider covered by my Insurer. I understand that my Insurer may limit the number of Tests covered per month, and that by ordering from another source, I may not have coverage for the Tests. I hereby authorize and direct, to the fullest extent covered, my health insurer or other healthcare benefit program (generically “Insurer”) to pay my provider all amounts due and owing for the at-home COVID test kits (“Tests”) ordered by me or on my behalf by an appropriate guardian or caregiver. I understand that the Tests will be mailed to me, and that the Provider has hired third-party vendors to facilitate the communications, delivery, and ordering of the Tests for me. I give express written consent to the Provider and these vendors to contact me in the future regarding refill reminders or information about treatment alternatives or other health related benefits and services that may be of interest to me using my contact information provided to the Provider and/or the vendors. I acknowledge that the Provider has a no-return policy and I fully understand that I may be directly responsible to pay the Provider for the Tests, less any amounts paid by my Insurer. I acknowledge that I had the opportunity to opt-in to auto-enroll for monthly delivery of Tests, and in the event I elected for this service, I understand and acknowledge that Provider will contact me prior to each following shipment to confirm I still want the future shipment.