**Consent and Authorization:**

I, the undersigned, consent to the collection of my health information for the purpose of blood tests and sample collection for diagnostic purposes by Luxe Diagnostics LLC.

I authorize the release of my health information to relevant healthcare providers and laboratories involved in the testing process.

**Privacy and Security: **

I understand that my health information will be kept secure and confidential.  Luxe Diagnostics  implements security measures to protect my health information, including encryption and secure storage.

**Retention and Disposal: **

I acknowledge that my health information will be retaining 7 years and will be securely disposed of when no longer needed.

**Patient Rights: **

I understand that I have the right to access my health information and request amendments as necessary under the Health Insurance Portability and Accountability Act (HIPAA).

**Contact Information: **

If I have questions or concerns regarding my health information or privacy, I can contact Santonia Coleman at 877-952-4980.

**Acknowledgment of Receipt: **

I acknowledge that I have received a copy of the HIPAA Notice of Privacy Practices from Luxe Diagnostics LLC and signature is on phlebotomy consent form which is signed at prior to any collections.