This disclaimer provides Predicine, Inc. with your permission to
perform a COVID-19 screening procedure. By checking the box, you are
indicating that you voluntarily consent to this procedure for the
detection of COVID-19. The test being administered involves a nasal
swab that will be tested to indicate the potential presence of
COVID-19. This test has been EUA approved by the FDA, however, this
test alone may not be sufficient to detect or rule out the possibility
that you have been exposed to or are infected with COVID-19. You
should carefully monitor your own symptoms and, notwithstanding the
results of any testing, you must stay home and consult with your
physician if you experience symptoms of COVID-19. You have the right
to discuss the proposed testing with your physician, to learn about
the purpose, potential risks and benefits of any testing. Because of
the ongoing public-health crisis, Predicine, Inc. is required to share
the results of your test with public health authorities.

By checking the box, you consent to the disclosure of such information
as requested, recommended or required by federal, state, and local
public health authorities.

By checking the box, you agree to release and waive any claim arising
from your selection to receive this voluntary screening, that may
arise against Predicine, Inc. and its designated medical providers and
staff members. Additionally, you agree to release and waive any claim
that might arise against Predicine, Inc. and its designated medical
providers and staff members for any risks, side effects, or
complications resulting from the testing.