1. I request a total of 8 tests.

2. I give complete authorization of shipment on behalf of family members on my insurance plan.

3. I understand that if requested items are not covered by my insurance plan, I will not be billed directly. I understand that I will be notified if my insurance plan does not cover the requested items.

4. I agree that all information that I have provided belongs to me, and is accurate.

5. I agree to text message communication and am able to respond with STOP to discontinue messaging.

6. I agree that I will not use these tests for employment or resale purposes as well as I will not use these tests in lieu of requirements for travel

7. I agree that I have not already received COVID-19 tests in this month.

8. I agree that I will not use these tests for children less than 2 years old.

9. I authorize auto-shipment of COVID-19 tests and understand I can opt out by emailing my request to pharmacyforlife.help@gmail.com