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Antibody Intake Form

Antibody Intake Form

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Height
  • Relevant Past Medical History/Risk Factors
  • I understand that this test looks for antibodies to COVID-19, NOT the virus itself. Testing for viral DNA, via PCR analysis, is performed only in specifically designated places and on patients who meet a strict pre-test criteria. I am electing to have this antibody test to assess whether or not I have been exposed to the novel coronavirus in the past. I additionally understand that if I choose to have this test fewer than seven days after the resolution of symptoms, the results may be less reliable. I hereby attest that I have been advised to take this test only as a completely asymptomatic individual. I have never had symptoms or at least have been symptom-free for seven days. I also understand that the results of this test may be given to the department of health or CDC for their statistical and demographic value. Once I am given my results for this test, I understand that they are only a preliminary measure of IgG/IgM antibodies (qualitative measure) and that the values of antibodies (quantitative measures) may vary. This test does not guarantee immunity to COVID-19 or any other virus.
  • Date Format: MM slash DD slash YYYY

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New York City

70 East 55th Street, 2nd Floor New York, NY 10022

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