Consent and Authorization for Services

Version 1.1 updated 09/09/2025

Welcome. You have requested to participate in wellness screening and testing Services through your Wellness Provider. The Services are managed by AltusDX who has been contracted by your Wellness Provider to ensure compliance with all regulatory, security, and privacy requirements. We require your confirmation, consent, and authorization for the statements and information presented below to use the Services.

1. Eligibility and Use

I certify that am at least 18 years old and located in the United States when I collect my specimen. The Services are intended for adults aged 18 and older.

The Services are not offered in New York. I will not collect or mail a specimen from New York, and I will ship my specimen from a U.S. location using the prepaid mailing materials.

I will follow all instructions included with the Services and in the portal.

2. Nature of the Services

I understand that the Services are for informational screening and wellness purposes only. They are not a substitute for medical advice, diagnosis, or treatment.

I understand that laboratory tests have limitations. Results can show false negatives or false positives. The testing lab provides measured values and details the reference ranges for screening and wellness purposes.

My use of the Services does not establish a doctor-patient relationship with AltusDX or with its employees, agents, or contractors. I agree to discuss any questions about my results with my own qualified health care professional.

3. Emergencies and Adverse Events

I understand that the Services are not for urgent or emergency use.

Please Note: If you have symptoms or an emergency, call 911 or seek in-person care. If you experience an adverse event related to specimen collection, please contact your healthcare professional and notify AltusDX at [email protected] so we can record the event and assist with the next steps.

4. Specimen Collection and Risks

I have the capacity to consent, and all the information I give is accurate and complete.

I understand that specimen collection may include venous blood, capillary blood, finger stick blood, urine, saliva, or other validated methods.

I understand that capillary and finger stick collection uses a sterile, single-use lancet to collect blood drops. This may cause brief discomfort. There is a rare risk of infection at the puncture site.

I will follow all collection and safety instructions to reduce any risk of infection or injury.

I certify that the specimen I submit is my own and has not been substituted, diluted, or otherwise adulterated.

5. Your Sample Specimen and Quality Assurance

I understand that after I mail my specimen, it will be consumed for testing by the performing laboratory or will be disposed of according to the laboratory’s policies and laws. Residual material may be used in de-identified form for quality assurance, method validation, and laboratory controls.

6. Laboratory Testing and Timing

I understand that my specimen will be analyzed by a laboratory in the United States that is certified by the Centers for Medicare & Medicaid Services (CMS) under the Clinical Laboratory Improvement Amendments (CLIA) regulations.

I understand that typical processing time is 1 to 5 business days from the laboratory's receipt. Timelines may vary and are not guaranteed.

I understand that if a specimen cannot be tested due to issues with collection, labeling, stability, shipping delays, temperature extremes, or other factors, a re-collection may be necessary.

7. Communications and Alerts

Two-way SMS and online Chat support is available for assistance with the Services. By initiating an SMS message conversation or online chat session, I consent to receive SMS and Chat responses related to your support request. If I opt out of SMS messages by replying “STOP” I may restart support at any time by sending a new text message. Message and data rates may apply depending on the mobile carrier.

By providing my mobile phone number and email address, I agree to receive SMS text messages and emails related to the Services, such as appointment details, status updates, reminders, and other important service information. Message and data rates may apply for SMS text messages.

My test results and personal health information (PHI) will be accessible in a secure portal and will not be sent by SMS, Chat, or email. I understand that I may not send PHI through these communication channels.

My communications consent is voluntary, and I can update my preferences at any time. I may opt out of text messages by replying “Stop” and I may opt out of emails or by clicking the “Unsubscribe” link. I may also opt out of text messages or emails by contacting help@testing-support.com.

8. Use and Disclosure of My Information

My information may be used or disclosed without additional authorization for treatment, payment, and healthcare operations. This includes test ordering and review by a licensed clinician, laboratory analysis and reporting, secure delivery of results, quality assurance, and related customer support.

For these purposes, AltusDX and its contracted vendors may act on behalf of the ordering or reviewing clinician or the laboratory, as applicable, under the relevant privacy rules.

I have a right to receive my own lab report.

9. Limited Authorization for Program Administration

I authorize AltusDX, the CLIA-certified laboratory, and the ordering or reviewing clinician to share my test results and limited identifying information, such as my name, date of birth, contact details, and test ID, with my Wellness Provider solely to administer the program.

I understand that disclosures will be restricted to the minimum necessary for eligibility checks, shipping and returns, support, incentive processing if applicable, and similar tasks. I may opt out of further sharing related to program administration after my test is complete by contacting [email protected].

I understand that this authorization lasts until the earliest of (a) completion of the testing Services and any required quality assurance checks, or (b) one year from the date I accept this consent.

I may revoke this authorization at any time by emailing [email protected]. Revocation stops future disclosures made under this authorization but does not undo disclosures already made in reliance on it.

I am not required to provide this authorization to receive care from my health care providers, but AltusDX cannot facilitate these testing Services without it.

I understand that my Wellness Provider may not be subject to HIPAA and that they will handle my information according to their Privacy Policy.

I understand that AltusDX is subject to HIPAA rules and will continue to handle my information under HIPAA rules and its Privacy Policy.

10. Important Acknowledgments

I understand that only a licensed clinician may provide explanation, diagnosis, or treatment advice. Any clinical evaluations or authorizations are conducted by independent licensed professionals or organizations that maintain their own professional standards and privacy obligations.

At-home collection takes place in my own environment, and I am responsible for following all instructions and safety protocols.

11. Assumption of Risk and Limitations

To the extent permitted by law, I assume the risks associated with not following instructions, misusing the kit or supplies, making decisions based on results, and carrier delays, loss, damage, or other acts or omissions by independent third parties.

Nothing in this consent limits any non-waivable rights or applies to claims caused by gross negligence, willful misconduct, or legal violations by AltusDX or the Wellness Provider. The disclaimers, liability limits, and indemnities in the AltusDX Terms and Conditions also apply.

12. Electronic Delivery and Signatures

I agree to receive notices and communications electronically, such as through a secure portal, email, or SMS, where available. I also consent to the use of electronic signatures and records for this purpose.

By registering for Services and submitting a specimen, I confirm that I have read, understand, and agree to this consent and that I wish to participate in the testing Services and authorize the processing described above.

For questions about this consent and authorization, please email [email protected].

Terms

Support

Our mission is to help elevate health

by empowering passionate wellness

organizations with advanced testing

and digital health solutions.

AltusDX is a healthcare technology and service facilitator. We are not a clinical laboratory, medical provider, or telehealth practice. All laboratory testing is performed by independent CLIA-certified laboratories, and any clinical review, oversight, or telehealth services are provided solely by independent licensed professionals. AltusDX does not provide medical advice, diagnosis, or treatment. The information and services we provide are for operational and wellness-related informational purposes only and are not a substitute for professional medical care or advice. Any medical questions should be directed to a qualified healthcare provider.

Terms

Support

Our mission is to help elevate health by empowering passionate wellness organizations with advanced testing and digital health solutions.