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The Advance Tests Alzheimer's test uses a blood sample to test for several analytes associated with Alzheimer’s Disease. Phlebotomy is concerned with the inserting of a needle into the arm or hand to gain access to a vein for the purpose of withdrawing blood. Please read this form carefully and if happy to proceed, give your consent to the procedure.

 

Risks Associated with Phlebotomy

While rare, there are risks associated with phlebotomy.

 

Risk from having blood drawn:

• Development of a hematoma at the site of venipuncture.  This risk is minimised if you are not taking blood thinners which can be medical or other supplements such as vitamin C, fish oils, aspirin, alcohol.

• Drop in blood pressure so that you may feel dizzy and even possibly faint. It is important that you notify the phlebotomist if you feel any adverse symptoms at all during the procedure so that the venipuncture can be immediately stopped and appropriate action taken.

• A slight scratch at the time which can be minimized by hydrating well.

• The possible slight pain or stiffness after the blood draw which should disappear and often is reduced if you are well hydrated.

• The possibility of not being able to draw blood after multiple attempts. This can be due to de-hydration, medication, disease and illness as well as other issues.

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Informed Consent

I am aware of the possible risks and benefits associated with phlebotomy. I have made the practitioner aware of any pre-existing condition that I have that might put me or others at risk through my participation. I can withdraw consent at any time and stop the procedure by informing the practitioner.

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I agree that I have not withheld any information about any medical condition and that to the best of my knowledge I am fit to receive bloodletting therapy. I will inform my practitioner when and if there are any changes to my health or if I feel that there is any doubt as to whether I should receive treatment.

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I understand that the practitioner cannot be held responsible or liable for any adverse side effects or reactions that may occur as a result of the venipuncture. I understand that the blood testing and results information are not intended to be a replacement for medical treatment and clients are advised to always consult with a qualified doctor before adopting any of the suggestions implied by the results.

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I hereby understand that by its very nature, bloodletting may cause minor discomfort and may irritate the skin or leave a mark, puncture of the skin or at times significant bruising.

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I understand that it is not always possible to obtain blood at the visit and I may have to re-book another appointment if blood cannot be obtained.

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I have read and understand the terms of this agreement and I hereby consent to proceeding with the blood test.