I hereby confirm that all information provided by me above, including but not limited to my full name, address and date of birth, are true, complete and correct to my knowledge. I agree that I can give proof of this information should it later be required or requested. I understand that legal action can be taken against me if it is later found that I have provided false and/or fraudulent information *

I am aware and agree that the samples being taken will be used to test for CoVID-19 and PureFlo Health and or their associated companies are permitted to use the samples as they deem appropriate. *

I am aware why I am providing a sample and I agree to my results being shared with my employer. *

submit