Benefits of NMS
Benefits of NMS
Town of Palm Beach
(THIS AUTHORIZATION EXPIRES ONE YEAR AFTER IT IS SIGNED)
Please enter information of those taking Quest and Labcorp based Coronavirus Test.
Date of Birth
Sending Records From
NMS Management Services, Inc/Quest
2901 S. Congress Ave
Sending Records To
Town of Palm Beach/ Danielle Olson & Kennie Wells
360 S. County Rd
Type of Medical Request
All Laboratory Results
The laboratory is required to report all testing performed to the department of health.
I authorize the release of my COVID-19, Corona Virus , Antibodies Test Results, whether negative or positive to the person(s) listed above. I understand that the person(s) listed above will be notified that I must give specific written permission before disclosure of these test results to anyone.
You acknowledge and understand that NMS shall not be liable and shall be held harmless for any discomfort or any other derivative consequence of the process of specimen collection. It is understood that the process of collecting the specimen itself may involve an invasive process that can result in reflex reaction by the subject during the collection process. Further, it is understood that NMS is not responsible for the result or any consequence imposed upon the subject due to the result of the testing.
I understand the following disclaimer.
The COVID-19 Immunity (IgG) test does not directly detect the virus and should not be used to diagnose or exclude COVID-19 infection. A negative result may occur if you are tested early in your illness and your body hasn’t had time to produce antibodies to infection. Even if your COVID-19 Immunity (IgG) test is positive, that does not mean you are immune to COVID-19. If you suspect you may be infected with COVID-19, you should talk to your healthcare provider, and direct testing for the virus, COVID-19, should be performed.
Address Line 2
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Copy of Driver's License
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