CONSENT AND RELEASE FORM
I hereby request and consent to the drawing of blood sample(s) and receipt of lnformation for the test(s) performed. I hereby release Lipid labz Inc Florida Laboratory Services and any other organizations associated with this screening., parent and affiliated companies, successors and assigns. officers. directors. and employees from any and all liability arising from or in any way connected with blood drawing for the indicated test(s), measurement(s) or from data delivered there from. I understand that the data derived from this test(s) is to be considered preliminary only and does not constitute a diagnosis. The responsibility for initiating a follow-up examination and obtaining professional medical treatment is mine and not that of the organizations associated with this testing service.