Consent to testing and to the processing of your health information
Please read this page before your blood draw. Ask the nurse or email us if anything is unclear. Signal is a wellness and prevention service; it does not replace your doctor.
1. Your details
Full name
Date of birth
ID or passport number
Mobile
Email
Home address (visit address)
Your GP (optional)
Visit: Baseline / Progress retest / add-on
2. What we do
A registered nurse collects a blood sample and takes simple body measures at your home. Samples are analysed for the markers in your membership visit, plus any add-on you choose. A registered medical practitioner reviews every result and writes the summary in your report. Your report presents markers against optimal and reference ranges for wellness and prevention. It is not a diagnosis. If a result warrants clinical follow-up, the reviewing doctor will contact you directly and refer you appropriately.
3. Consent to testing (tick each)
I consent to the collection of a blood sample and simple body measures by a Signal nurse, and to the analysis of that sample for the markers in my membership visit and any add-on I choose.
I understand that fasting for 10 to 12 hours is recommended for a morning draw, that minor bruising can occur, and that I can stop the visit at any time.
I understand that a registered doctor reviews my results and may contact me about any finding that needs medical attention, and that Signal does not provide emergency or acute care.
4. Your information (Protection of Personal Information Act)
Health information is special personal information under POPIA and needs your explicit consent. Signal Health is the responsible party. Our Information Officer can be reached at info@signalhealth.me.
I consent to Signal collecting and processing my personal and health information for the purpose of providing my membership visits, my report, doctor review, and follow-up on my results.
I understand that my sample is analysed by a registered pathology laboratory in South Africa (or by Signal's own laboratory once it is running) under the reviewing doctor's request, and that such laboratories process my information only for that purpose.
I understand my results are stored securely, identified by a sample number separately from my name, kept for five years unless I ask for earlier deletion, and never sold or shared with employers, insurers or marketers.
I know I can ask what information Signal holds about me, correct it, or ask for it to be deleted, by emailing info@signalhealth.me, and that I can complain to the Information Regulator (inforegulator.org.za).
Optional: I would like Signal to send me occasional updates and member news. (You can opt out at any time.)
Client signature and date
Client name (print)
Signal nurse (witness) and SANC number
Copy retained by Signal Health and available to you on request. Sample ID: ____________ Draw time: ________ Fasting confirmed: Y / N