TENDER TOUCH MOBILE PHLEBOTOMY SERVICE
Agreement Form
Tender Touch Mobile Phlebotomy service is responsible for the drawing and handling of laboratory specimens. Tender Touch does not collect any specimens without a physician order or a request from a laboratory. Tender Touch is not allowed to give any medical advice, treat or diagnose anyone.
Tender Touch handles the delivery of all samples to their proper laboratory. Under no circumstances will a client be given a sample to handle. If a sample is being collected for a laboratory that needs to be picked up via courier service, Tender Touch is not responsible for any delay of arrival to the laboratory, due to weather conditions or any other problems that my occur once the sample has been delivered or picked up by courier service.
Tender Touch is not responsible for any errors that may occur at the laboratory. In the event of a lab error, Tender Touch would gladly return to recollect the sample at a discounted rate. Any error made by Tender Touch will be corrected at no extra charge.
Any billing questions or problems for tests collected for this service should be directed to your insurance company or the laboratory billing department. Payment for Tender Touch service is collected on the date of service. Tender Touch does not bill insurance companies, any claims must be submitted by the client.
Tender Touch is an independent mobile phlebotomy service. Tender Touch dose not have any ties to any laboratories or doctor’s offices. Tender Touch does not have the authorization to give discounts for any lab tests that are being collected.
Under no circumstances will Tender Touch give out clients personal information to unauthorized personnel. All clients information is always kept personal and confidential.
I understand the above terms and conditions and agree to have my lab sample collected.
_____________________ _________________ Print Name Name of Lab _____________________ __________________ Signature Date |