Loading

First Name *

Last Name *

Gender *

Date of Birth *

Email

Phone number

We use email to send confirmation and results. You can continue without an email and a phone by selecting 'No email' and 'No phone'.


Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.


Notice of Informed Consent

I hereby release Alere Corporation, PTS Diagnostics, Heart Watch 2, other organizations associated with this screening, parent and affiliated companies, successors and assigns, and officers, directors, and employees from any and all liability arising from or in any way connected with fingerstick blood collection for my blood cholesterol and glucose or from the data derived therefrom. I understand that:

1) The data derived from these test are to be considered preliminary only and do not constitute a diagnosis of hypercholesteria or diabetes.
2) These tests do not pose any serious health risks. Fingerstick punctures, as with any cut or laceration, could become infected if proper precautions are not taken. A small percentage of people may feel faint during the procedure.
3) The responsibility for initiating a follow-up examination to confirm high blood cholesterol or high blood sugar and obtain advice and treatment is mine and not that of my physician or the organizations associated with this screening.
4) Personal data will never be shared with any entity without my express written permission.


Signed at {{participant.informed_consent.signed_at}}

Remove consent