COVID19 Rapid Test Consent Form

You are receiving this form because Prosper Home Care is alerting you to potential Covid-19 exposure.  Prosper Home Care advises that you shelter in place and follow all CDC precautionary guidelines to protect yourself and others from the possible spread of Covid-19.  These measures include wearing a mask, frequent hand washing, wearing gloves, not touching your face or eyes and keeping a minimum of 6 feet of distance between you and others whenever possible.  Please refer to for the most up to date Covid-19 information.  If the test provided through Prosper Home Care indicates positive for any Covid 19 antibody, we advise you seek a laboratory reviewed Covid test ASAP.

By signing this form you acknowledge that Prosper Home Care can not guarantee that the results of these tests to be 100% accurate. Signing this form also serves as acknowledgement that will hold Prosper Home Care, it’s owners and all affiliates “Harmless” against any potential liability claims.  Be well.

Place a checkmark next to each symptom that you are currently experiencing. If no symptoms are present, please check the box "No Current Symtpoms." *
Signature of Test Taker or Legal Guardian *
Powered byFormsite