• CROSS Consent & Processing Form

  • I give my consent to have myself or child/dependent to be tested for SARS-CoV-2 also known as the virus that causes COVID-19. I understand and give my consent for Polymerase Chain Reaction (also known as PCR) test, Rapid Antigen, and/or Molecular testing to be performed via Bilateral Anterior Nasal, Deep Nasal, Oropharyngeal, and/or Nasopharyngeal collection methods by a trained professional performing within the scope of their practice and approved by Health Canada and regulatory bodies. I understand and accept any risks associated with the testing procedure, such as minor irritation and/or bleeding, possible transfer of infection from the testing nurse to me or my dependent, or any other unforeseen conditions or complications. I will also disclose any nose, face or sinus injuries, surgeries or conditions to the individual performing the test prior to each collection.

    I authorize Pulsar UV Inc. to collect and confidentially store my personal information for repeat testing and communication purposes for the duration of the production, and laboratory results for ten years as per standard healthcare practice. I also authorize Pulsar UV Inc. and the laboratory(s) they use to release my/my dependent’s test results, and share said results with the employer/production providing this testing, the production’s/workplace’s appointed COVID-19 Health and Safety representative(s), Public Health, my department head/managing body(s), and within Pulsar UV Inc. via email, phone, text, and/or fax. I accept any risks associated with the transfer of my/my dependent’s health information through communication (ie. a possible leak, hack, breach in security, etc.).

    I understand that I will only be notified if I receive a positive result, in which case, my employer, manager, supervisor and/or production, and/or relevant department heads and/or appointed COVID-19 department representatives will be notified, Public Health (by law) will be notified, and I will be required to follow all current Public Health guidelines for the area. I may request to receive my official lab results at any time during and two weeks following my production’s testing period via email to my production, employers, appointed COVID-19 representative, or directly to Pulsar UV Inc.

    I understand that with any form of current testing, there is a chance of a false negative or false positive result and I will continue to adhere to all COVID-19 safety protocols set out by the government, my production and/ or workplace regardless of my/my dependent’s test results, and render Pulsar UV Inc. and any associated laboratories they may use, harmless of any damage or harm should a false result be reported. This consent will extend and cover all future testing dates with Pulsar UV Inc. with my current employer/production. I understand I may withdraw my consent at anytime in formal writing to info@pulsaruv.com

    For other helpful links and Public Health guidance, please go to pulsaruv.com/publichealthlinks

  • Clear
  • Patient Information

  • Should be Empty: