• I authorize Priority Medical Group and its affiliated practitioners and staff to facilitate a COVID-19 test through a saliva or nasal swab test, as ordered by an authorized medical provider or public health official.
  • I authorize my test results to be disclosed to my employer, the county, state or to any other governmental entity as may be required by law.
  • I acknowledge that a positive test result is an indication that I must continue to self-isolate in an effort to avoid infecting others.
  • I understand that as with any medical test there is the potential for false positive or false negative test results can occur.
  • I acknowledge that I have been given a copy of Priority Medical Group’s, Notice of Privacy Policy.
I, the undersigned, have been informed about the test purpose, procedure, possible benefits and risk. I have received a copy of this informed consent. I have been given the opportunity to ask questions before signing and I have been told that I can ask questions at any time. I voluntarily agree to testing for COVID-19 and to follow up encounters with Priority Medical Group and it’s providers for work release purpose.
Agreement for Self-Isolation 
The local health jurisdiction has determined that if you are under suspicion for having COVID-19 due to symptoms and testing requests, it is necessary to be placed in isolation in order to prevent the transmission of this infection. It is important for you to comply with this Isolation Agreement in order to protect the public’s health.
Your signature below confirms that you consent to COVID-19 testing and if you have any of the symptoms above, you will isolate yourself from other people until you receive a negative test result.