Testing Consent

Covid-19 Screening Form


Ethnicity *
This is so that we can contact you in a emergency.
Please confirm your email address


1. Have you developed any of the symptoms in the last 14 days that you suspect are COVID-19?
A fever higher than 37.8 degrees C? *
A new Continous Cough? *
A change in normal sense of taste or smell (anosmia)? *
If YES to any of the symptoms above please do NOT register for a test and seek medical advice immediately via 111


2. Have you previously been diagnosed with COVID-19 in the past or do you think you have had it? *
3. If YES when an how were you confirmed positive?
4. Are you or have you been in contact with anyone who has been sick and/or confirmed with COVID-19? *


What is an antibody test?

An antibody test can indicate if someone has had Covid-19 caused by the coronavirus in the past and has since recovered by analysing a blood sample.  The body makes antibodies when it fights infection.

What do antibody test results mean?

A positive antibody test demonstrates that someone has developed antibodies to the virus. The presence of antibodies signals that the body has staged an immune response to the virus.

COVID-19 is a new disease and our understanding of the body’s immune response to it is limited.  We do not know, for example, how long an antibody response lasts nor whether having antibodies means you cannot transmit the virus to others.

Our understanding of the virus will grow as new scientific evidence and studies emerge.

An antibody test result can only tell an individual whether or not they have had the virus in the past.  Antibody tests are also being used currently in surveillance studies to understand what proportion of the population have already had the virus.

If you test positive for antibodies, can you ignore lockdown restrictions?

No.  There is no evidence yet to suggest that those who have been proven to have had the virus are immune. This is the position of the World Health Organisation.

You should continue to comply with social distancing measures and Government guidelines. All infection, prevention and control measures (including PPE) must continue to be in place, irrespective of the presence of antibodies.

How will I be informed of the result?

The result will be securely passed to you directly via the email you registered with for the testing today.

Are there any risks to having the test?

A small blood sample is taken with a finger prick blood test.  There are some risks related to having a blood test, such as feeling dizzy and faint during and after the test, but nothing specific to this antibody test.  Risks can also include bruising at the finger prick site.  Serious complications, such as an infection at the site where blood was taken, are possible but generally extremely unlikely.


  • I confirm that I have read the above information and I consent for this procedure; I understand that my participation is voluntary and I am free to withdraw at any time, without my medical care of legal rights being affected.
  • I confirm that I have not tested positive for COVID-19 in the last 14 days.
  • I confirm that I am content for the result of my test to go directly to my registered email.
  • I have had the opportunity to consider the information and can confirm that I understand the nature and purpose of this procedure, together with the benefits and risks.
  • I have confirmed a positive test will not mean, at this point, that I am immune and, therefore, I will continue to behave as if I might get or pass on the infection, in accordance with PPE and social distancing provisions.
  • I declare that the information I have given on this form is correct and complete.  
  • I accept information relating to this test will be held under the rules governing medical confidentiality and the Data Protection Act 2018 by NTL Biologica Limited and its associated organisations involved in this testing. It will solely be used for data research purposes and will be destroyed on completion of the research.  I understand that relevant sections of my questionnaire and data collected during this test may be looked at by individuals from regulatory authorities or from NHS Trust/ Health Board, where relevant to research. I give permission for these organisations to have access to the collected data.
  • I confirm that I have been 14 days free of any of the recognised COVID-19 infection symptoms as declared in the Health Questions section.
Please now complete this form by signing, either by drawing a signature or typing it in...
GDPR Consent *

Statement of NTLB Technician

I have explained the procedure and nature of the tests to the client and confirmed that the result is sent directly to their registered email.