I hereby authorize the release of my completed laboratory test results (“Results”) to me via Systemic Labs, acting as my authorized agent, arising from laboratory services performed by a third-party laboratory provider.

I acknowledge and agree that:

(a) Prior to or simultaneous with my receipt of the Results, the Results will be provided to the licensed healthcare provider who ordered the laboratory test(s) (the “Ordering Provider”);

(b) The communication of the Results to me by Systemic Labs is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment;

(c) Systemic Labs does not replace, act as, or provide services on behalf of the Ordering Provider, and any questions regarding the meaning, interpretation, or clinical significance of the Results should be directed to the Ordering Provider;

(d) The communication of the Results does not include medical recommendations, treatment plans, or individualized medical guidance, nor does it constitute consideration for referrals or medical decision-making;

(e) I understand that Systemic Labs is not a HIPAA-covered entity and that the Results are shared with me for my personal informational use only.

By proceeding, I confirm that I have read and understand this authorization and acknowledgment.