COVID-19 Testing for Dentistry 🦷
Your dental provider has requested you to be tested for COVID-19 prior to seeking dental care. Please fill out the information in this form in order to get tested.
LynxDx COVID-19 Informed Consent
🦠 The test detects if you have SARS-CoV-2 (the virus that causes COVID-19) at the time of the test only. It does not test for immunity or if you had the virus in the past.
🧪 This test requires sample collection through a nasal, nasopharyngeal, or oral swab.
➕ If your results are positive, please contact a medical doctor immediately.
➖ Negative results mean that the virus was not detected. However, your test may have been a false negative. False negatives occur because the tests are not perfectly accurate.
🤒 If you're still feeling symptoms, contact a medical doctor and ask whether you should be retested because you may have contracted the virus after your test.
👨🏻⚕️ Only a medical doctor can give you a diagnosis. They can also provide information on how to care for yourself and to help protect others from infection. LynxDx DOES NOT and WILL NOT prescribe or order any drugs or other therapies, nor provide any diagnosis, in connection with the COVID-19 testing. This testing does not replace your existing relationships with your primary care medical doctor, family physician, or other health care providers. This testing IS NOT intended to make a medical necessity determination. This test is only intended for screening purposes for dental care.
⚠️ LynxDx DOES NOT provide medical advice or medical care. COVID-19 testing services provided are solely for informational and public health purposes. These services do NOT constitute medical care. If you are experiencing a medical emergency, immediately call your healthcare provider or 911 for immediate assistance.
📋 Your results will be reported back to you by your dental provider. LynxDx will NOT report results to you. Please contact your dental provider for results.
✍🏻I consent to my results being reported to the dental provider I have selected on this form
🏛 Your results will be shared with appropriate public health agencies when required by law.
Informed Consent Acknowledgement
I acknowledge that I have read, understood, and agree to the above LynxDx COVID-19 Informed Consent.
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