Form

Phlebotomy Waiver

    Patient Information










    Phlebotomy Procedure Consent and Liability Waiver

    Acknowledgment and Assumption of Risks


    • Bruising, pain, or discomfort at the site of needle insertion
    • Infection at the puncture site
    • Lightheadedness, dizziness, or fainting
    • Hematoma (a bruise or swelling due to blood leaking outside the vein)
    • Nerve irritation or damage

    Consent to Proceed

    By signing this document, I affirm that:



    Release of Liability


    Agreement

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