Laboratory Test Sample Collection Consent

I, , hereby consent to the collection of biological samples (such as blood, urine, saliva, etc.) from myself for the purpose of laboratory testing as recommended by my healthcare provider.

Information Provided

I have been informed about the nature and purpose of the test(s) to be performed.
I understand the sample collection procedure and the potential associated risks or discomforts.
I am aware that my results will be kept confidential and shared only as permitted by law or with my explicit permission.

Consent

I voluntarily agree to provide the required sample(s) for laboratory analysis. I understand that I have the right to ask questions and withdraw my consent at any time before the collection of the sample(s).

Patient Name

Date of Birth

Signature

Date

Witness Name (if required)

Witness Signature