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Hibernian Health Check – Patient Consent Form

Last updated: 15Jun2021

Dear Patient,

Please read thoroughly the Privacy Policy and below information before agreeing to this consent form. If at any point you have any questions, please ask our Test Coordinator who will be happy to discuss this information with you. If you have any further queries, please feel free to call our office on 01 460 4820. By agreeing to this consent, you acknowledge that:

  • You are aware this test is testing for a COVID-19 infection.
  • You are aware that your test results will be shared directly with me.
  • You are aware it is your responsibility to ensure the result you receive from HHC is appropriate and accepted by your destination country and/or airline (if applicable).
  • You are aware positive test results will also be disclosed to the HPSC.
  • You have received a link to the data privacy notice from HHC and are aware
    1. of your rights around your personal data
    2. that your data will be managed carefully
    3. your data will be handled in accordance with GDPR


During the visit the following services may be supplied:

  • Throat and Nasal Swab or Saliva Collection for Nucleic Acid Identification (PCR) SARS-CoV2 RNA or a Rapid Antigen test kit for identification of the SASRS-CoV2 virus.


By agreeing to this consent document, you agree that:

  • That you consent to be treated by a Hibernian Health Check Test Coordinator
  • That you have read and understood this consent form and the privacy notice in their entirety
  • That you are happy with the information provided by the documentation

If you have any queries, please email us on