Enzo Clinical Labs
60 Executive Boulevard
Farmingdale, NY 11735
Consent Form for Minors Undergoing COVID-19 Testing
As the parent or guardian of the minor student named below, I authorize Enzo Clinical Labs' personnel to collect and test a nasal sample from said
student for the presence of SARS-CoV-2 in order to access and remain in school. I also consent and authorize any physician, authorized provider,
or Enzo Clinical Labs to use or disclose protected health information related to the testing of the sample solely for reporting purposes or any
other purpose as required by law or regulation.
Furthermore, I understand the potential risks of this procedure include but are not limited to:
Possible slight discomfort, runny nose (rhinorrhea) or possibly a slight nose bleed that can happen during sample collection.
Potential benefits include:
The result, along with other information, can help you make informed decisions about your care.
The results of this test may help limit the spread of COVID-19 to your family and others in your community and the school's community.
Student Date of Birth
Parent/Guardian Name *
*Copy of the Consent form will be emailed to the Parent.