AccuGen Diagnostics LLC.

1000 Iris Dr. Sw Suite D-200 Conyers Ga 30094

Phone Number 470-610-3922 Fax Number 470-998-2671

STD Consent Form

I understand that AccuGen Diagnostics LLC provides laboratory specimen collection and testing services only. AccuGen Diagnostics LLC does not diagnose, treat, or provide medical advice regarding any condition, including sexually transmitted diseases. I acknowledge that all test results are for informational and screening purposes, and it is my responsibility to consult a licensed healthcare provider for interpretation of results, medical evaluation, treatment, or follow‑up care as needed.

Purpose of Testing

I am voluntarily requesting laboratory testing for sexually transmitted diseases (STD'S) through AccuGen Diagnostics LLC.

Scope of Services

• AccuGen Diagnostics LLC does not diagnose, treat, or provide medical advice

• AccuGen Diagnostics LLC provides specimen collection and laboratory testing services only.

• My results are for informational and screening purposes.

• I am responsible for consulting a licensed healthcare provide for interpretation, diagnosis, treatment, and follow-up care.

Consent to Testing

I voluntarily consent to:

• Collection of my specimen(s)

• Laboratory Processing

• Secure release of my results to me or the ordering provider

I understand certain tests may require blood, urine, or swab specimens and I consent to the appropriate method.

Confidentiality

AccuGen Diagnostics LLC maintains strict confidentiality. My information and results will not be shared without my written authorization, except as required by law.

Acknowledgment

Collector Signature: