Authorization & Acceptance

TERMS & CONDITIONS: BY SIGNING THIS FORM, YOU HAVE READ AND AGREE TO DISCLAIMER AND Submit Samples to: THE TERMS AND CONDITIONS SET FORTH (THE "AGREEMENT") governing your purchase of services (“Services”) from United Bio-Research Inc.. If you are entering into this Agreement on behalf of a company or other legal entity, you represent that you have the authority to bind such entity to these terms and conditions, and that such company or entity shall be financially responsible for any amounts or balances owed or that may accrue, in which case the terms "you" or "your" shall refer to such entity. This Agreement shall be governed under the laws of Utah, United States.

I have read, signed and understand the HIPPA privacy agreement. Required for all 18+ individuals. **If you have already signed in the past, you don't have to resign. View & SIgn HIPPA privacy agreement

I understand that my results cannot be used for clinical or diagnostic purposes

I agree to release my data to my spouse, father, and patriarch

I understand and agree, that if I bill an insurance account, and it gets rejected, i will be responsible for payment.

Authorization & Acceptance

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