PancreaSure Collection

By signing below, you agree to the following:
Test: I give consent for PancreaSure testing. I understand this is a test that will measure 5 biomarkers and combine them using an algorithm to detect pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreas cancer.
Billing: The PancreaSure Promise has been explained to me. I understand that if the out-of-pocket cost of my test will be more than $200, an Immunovia representative will call before my test is processed to discuss the cost and review my options, including cancelling the test.
I consent to Immunovia obtaining a consumer credit report on me to confirm whether my income qualifies me for financial assistance. This inquiry is used only to confirm my income and will not affect my credit score. If I am determined to qualify, I authorize automatic enrollment in the Financial Assistance program. I agree to provide Immunovia with any additional information or documentation that may be needed to confirm qualification for the program.
I understand that Immunovia will send me a statement for any balance due after the test has been completed. I agree that I will pay the full amount of this statement to Immunovia.
Communication: I understand I may be contacted about the PancreaSure testing process. By providing my email address and phone number below, I consent to receive secure communication from Immunovia.
Sample Disposition: Unless I contact Immunovia to request otherwise, my deidentified sample may be used for test validation, or educational and/or research and development purposes, in accordance with appropriate regulatory guidances and Immunovia standard operating procedures. I will not be compensated for this use.
I understand that I may revoke consent for research or future communication at any time by contacting Immunovia, Inc. at [email protected] or 833-593-9522.