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2019 Novel Coronavirus (COVID - 19)
Please fill out the form below to get started with your test. This information will be used to notify you of your test results when they become available. If you have any problems with this form please contact 864-679-2970 and let them know you need to schedule testing for
Consent/Insurance Release: I voluntarily consent to the collection and testing of my specimen and certify that the specimen identified on this form is my own; it is fresh and has not been adulterated in any manner. I certify that the information provided on this form and on the specimen container is accurate. I further authorize Premier Medical Laboratory Services to release the results of this testing to the ordering facility. Furthermore, I hereby authorize my insurance benefits to be paid directly to Premier Medical Laboratory Services. I acknowledge that Premier Medical Laboratory Services may be an out-of-network provider for my insurance plan. I consent for Premier Medical to file an appeal if my insurer denies the claim. I have been informed that in certain circumstances my insurance company may send the payment for services provided, directly to me instead of to Premier Medical Laboratory Services. Under law, I acknowledge that this does not release me from responsibility of my debt. I agree to endorse the insurance check and forward it to Premier Medical Laboratory Services within 30 days of receipt. Failure to do so could result in my account being forwarded to collections and reported to a Credit Bureau.
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We are committed to helping physicians provide the best care to their patients. Every day we strive to keep this commitment and to be the industry leader. We are committed to a tradition of excellence and will exemplify the highest standards of integrity, honesty, and ethical conduct in all we do. We believe our success depends upon our ability to listen and appropriately respond to the clients we serve. We invite you to give us the opportunity to develop a lasting and meaningful relationship.