I hereby acknowledge that I have voluntarily chosen to undergo a phlebotomy procedure at Health Link Mobile Phlebotomy LLC. I understand that phlebotomy involves inserting a needle into a vein to draw blood, which will be used for therapeutic or diagnostic purposes.*

I acknowledge that, as with any medical procedure, there are inherent risks associated with phlebotomy include but not limited to:

• Bruising, pain, or discomfort at site of needle insertion

• Infection at the puncture site

• Lighth headedness, dizzines, or fainting

• Hematoma a bruise or swelling due to blood leaking outside the vein)

• Nerve irritation or damage

I understand that while the staff at Health Link Mobile Phlebotomy LLC will take all appropriate measures to minimize risk, all medical procedures come with potential risk*

I have discussed any concerns I may have about the phlebotomy procedure with a healthcare professional MD.*

I have had the opportunity to ask questions related to the procedure and have received satisfactory answers*

I have informed the Healthcare professional of my complete medical history, including any condition, medication that may affect the outcome of the phlebotomy procedure.*

I consent to the performance of the phlebotomy procedure under the terms described herein.*

I hereby release Health LInk MObile Phlebotomy LLC, its employees, agents, and representatives, from any claims, damages, or rights of action directly arising from the phlebotomy procedure, except in negligence or intentional misconduct by Health Link Mobile Phlebotomy LLC or its staff.*

I have read this consent and liability waiver form carfully and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Health Link Mobile Phlebotomy LLC and I sign it of my own free will.*