Service Agreement and Payment Authorization

By proceeding with this request for service from Quick Lab Mobile (QLM), you acknowledge and agree to the following:

• Service Authorization
  You authorize QLM to provide mobile phlebotomy and/or diagnostic specimen collection services at your designated location. This applies whether the appointment is for you or on behalf of another individual.

• Billing and Payment Terms

  • All QLM services are self-pay and not submitted to health insurance.

  • QLM does not participate with or bill Medicare, Medicaid, or private/commercial insurance providers.

  • Certain services (e.g., LabKit collections or specialty tests) may require pre-payment or a deposit.

  • Any remaining balance will be automatically charged to the card on file after service completion.

• Responsibility for Accurate Information
  You confirm that all personal, patient, and payment information submitted is accurate and complete.

• Refund and Cancellation Policy
  Fees may be non-refundable for cancellations or missed appointments that do not comply with QLM’s cancellation policy.

• Consent to Contact
  By submitting this form, you authorize QLM representatives to contact you via phone, SMS, email, or other communication channels for the following purposes:

  • Appointment coordination or updates

  • Service instructions or follow-up care

  • Requests for feedback or satisfaction surveys

  • Occasional updates about new services or offers

  You may opt out of promotional communications at any time by replying “STOP” or contacting us directly.

• Informed Consent
  By signing below, you confirm that you have read, understood, and agreed to this policy. You voluntarily consent to receive QLM services and acknowledge your responsibilities under this agreement.