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DNA TEST ACTIVATION FORM

DNA TEST ACTIVATION &
HEALTH INFORMATION CONSENT

Activating Your DNA Test is Simple, Just Follow the 4 Steps Below:

Step 1. Purchase Your Desired Test.

Step 2. Collect Your DNA Sample

Step 3. Activate Your DNA Test by Completing this Health Information Consent Form.

Step 4. Ship Your DNA Sample with Your Completed and Signed Requisition Form, in the Provided Prepaid Shipping Envelope.

I am voluntarily submitting my DNA sample for analysis. If you are a parent or guardian consenting for your child or minor, all references to “I” are applicable to your child/minor. I understand that my sample(s) become the property of Safe Harbour Wellness and its Laboratory Partners. Safe Harbour Wellness or its Partners will never release any personal or identifiable information to a third-party without my consent.










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Note:

  • If Purchased through our SHW Online E-Store, You Received an Order Number on Your Purchase Receipt.
  • If Purchased through one of our Provider Partners, the Order Number will be written on your Requisition Form included within your Test Kit.

Regarding the phone or email consultation with our Physician, Pharmacist or Genomic Experts, the contents and recommendations are only given as an opinion and shall not constitute an official medical recommendation. Thus, the interpretation is given for information purposes only. Therefore, this information shall be interpreted in conjunction with other clinical findings and familial history under the guidance of your personal physician. Patients should seek appropriate health counseling from their doctor to explain the implications of this interpretation. Sole responsibility for the proper use of this information provided by Safe Harbour Wellness, their staff or associates, rests with the user, or those professionals with whom the user may consult outside of the Safe Harbour Wellness Team. Any information provided is not intended to diagnose, treat, cure or prevent a disease. These recommendations are for information purposes only, and an individual is not required to use such advice or products. These are recommendations only and do not replace the advisement of your own healthcare practitioner. By pressing submit, I acknowledge I have read this health consent form completely and agree to the terms outlined.