Our office follows all HIPAA guidelines. Your information is private and will not be shared with anyone outside of our office without a written consent from you.
In consideration of the risk of possible injury and safety that exists while participating in the Natural Acquired COVID Immunity Passport (hereinafter the "Activity"); and
In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following;
I am aware that the purpose of this website is to provide people with the knowledge of their natural acquired immunity and immunity status with or without receiving the COVID vaccine.
I am fully and personally responsible for my own safety, and actions while during my participation with the Acquired COVID Immunity Passport, and I recognize that not all facilities such as, but not limited to, bars, restaurants, stores, shopping centers, venues, offices, etc. may not participate or accept this Acquired COVID Immunity Passport.
I acknowledge that releasees are not responsible for errors, omissions, acts, or failures to act of any party or entity
I acknowledge that just because I may have the natural immunity antibodies does not mean I can not get the COVID-19 virus again.
I acknowledge that there is no personal or financial relationship between us and Labcorp, and that there may be additional charges from Labcorp after blood work is drawn.
I agree that this doctor-patient relationship is limited only to providing access to blood testing and the results. Our follow up is limited to providing you your test results as reported by Labcorp only. I agree to provide and respond with honest answers to this website and emails.
With full knowledge of the risks involved, I hereby release, waive, discharge the authors, providers of Natural Acquired COVID Immunity Passport, its board, officers, affiliate's, employees, successors, representatives, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury or death, that may be related to the use of the Acquired COVID Immunity Passport.
I agree to indemnify, defend, and hold harmless the authors/ provider, affiliates, employees of this website from and against any and all costs, expenses, damages, lawsuits, and or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to but not limited to injury, loss, or death from or related to the Natural Acquired COVID Immunity Passport and its opinions.
I hereby acknowledge that I have carefully read this "waiver and release" and fully understand that it is a release of Liability. I expressly agree to release and discharge the Acquired COVID Immunity Passport and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, Heirs, representatives, predecessors, successors, and assigns, from any and all claims or causes of action, and I agree to voluntarily give up or waive any rights that I otherwise have to bring a legal action against the authors/ provider of the "Natural Acquired COVID Immunity Passport" for, but not limited to personal injury, property damage, death, etc.
This waiver and release of liability shall remain in effect for the duration of my participation in the activity during this initial and all subsequent events of participation.
I acknowledge that I had the opportunity to email or contact the website and ask any questions regarding any issues or concerns I have about the testing, and I have full knowledge of what I am doing.
I understand that this doctor issued passport has no affiliation with the CDC COVID passport.
I agree that all information on this waiver form is correct and accurate.