At Kuon Healthcare, we are committed to ensuring the health and safety of all our customers. Please take a moment to complete the Patient consent and health declaration form before proceeding with any activities. Your safety is our top priority.
Purpose of the Test
I understand that the purpose of this blood test is to assess my health status and to provide laboratory results that may help in diagnosing, monitoring, or managing my health condition(s).
Pre-Test Instructions:
I acknowledge that I have been given clear instructions on how to prepare for my blood test, including whether fasting is required, and I understand the importance of following these instructions for accurate results.
I confirm that I have read the preparation guidelines provided and will follow them as advised.
Please tick any of the following conditions that apply to your past medical history:
Medications (Prescribed, Over-the-Counter, and Supplements):Please list any medications, including prescribed drugs, over-the-counter medications, and any supplements (such as vitamins or herbal remedies) you are currently taking. If you are not taking any medications or supplements, please write “None.”
I understand that some medications and supplements, including biotin or herbal products, can affect blood test results, and I have provided an accurate list to the best of my knowledge.
Allergies:
Please indicate any known allergies, including to latex, medications, or other substances. If none, please write “None.”
I understand that latex allergies or other allergies may affect the blood draw process or result in a reaction, and I have provided accurate information to the best of my knowledge.
Consent for the Blood Test:
I understand that the blood test will be carried out by a qualified professional.
I consent to the collection and analysis of my blood sample for the purpose of the tests I have selected or discussed with my healthcare provider.
I acknowledge that I have the right to withdraw my consent at any time before the test is conducted.•I understand that test results are confidential and will be shared with me as per the provider’s usual practices (via email)
Risks and Limitations:
I acknowledge that while blood tests are generally safe, there may be minor risks such as bruising, fainting, or infection at the needle insertion site.
I am aware that certain factors (such as taking medication, being dehydrated, or not following test preparation guidelines) could affect the accuracy of the results.
I understand that, in some cases, further tests may be required to confirm or clarify the results, and I agree to discuss these options with my healthcare provider if necessary.
Confidentiality and Data Protection:
I consent to the processing of my personal and medical data in line with the clinic/laboratory’s privacy policy and in compliance with UK data protection laws (GDPR).
I understand that my personal information and test results will be kept confidential and will not be shared without my consent, except where required by law or for medical purposes.
Responsibility for Follow-Up:
I understand that I am responsible for taking my blood test results to my GP or another appropriate healthcare professional for further discussion and interpretation. The clinic/laboratory does not provide medical advice or diagnoses based on the results and I acknowledge that it is my responsibility to ensure the results are reviewed in the appropriate clinical context.
Patient’s Declaration and Consent:
I confirm that I have read and understood the above information. I give my informed consent for the blood test to be carried out and for my personal and health information to be processed in accordance with the clinic/laboratory’s policies.
Thank You for Prioritizing Safety!
