Skip to main content Skip to main content Coronavirus (COVID-19) Testing»

Privacy, Terms & Conditions

Important note regarding website content.

If this is a medical emergency, call 911 or proceed to your nearest emergency room! Do not use our services, if you are experiencing a life-threatening emergency, loss of consciousness, difficulty breathing, chest pain, stroke symptoms, poisoning or overdose, head injury, uncontrolled bleeding, or other medical emergencies.



  • I voluntarily consent and authorize Vitality Urgent & Primary Care to conduct the collection, testing, and analysis for the purposes of a COVID-19 diagnostic test. I acknowledge and understand that my COVID-19 diagnostic test will require the collection of an appropriate sample by my healthcare provider through a nasopharyngeal swab, oral swab, or other recommended collection procedures. I understand that there are risks and benefits associated with undergoing a diagnostic test for COVID-19 and there may be a potential for false positive or false-negative test results. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have questions or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider or contact Vitality Urgent & Primary Care for consultation.
  • I authorize my test results to be disclosed to the county, state, or to any other governmental entity as may be required by law.
  • I acknowledge that a positive test result is an indication that I must self-isolate and/or wear a mask or face covering as directed in an effort to avoid infecting others.
  • I understand the testing unit is not acting as my primary medical provider, this testing does not replace treatment by my primary medical provider, and I assume complete and full responsibility to take appropriate action with regards to my test results. I agree I will seek medical advice, care and treatment from my primary medical provider if I have questions or concerns, or if my condition worsens.
  • I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result. I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this Informed Consent. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask additional questions at any time. I voluntarily agree to this testing for COVID-19.

Pre-Travel and Corporate Covid-19 Testing Disclaimer

  • I understand that Vitality Urgent Care will not be submitting a bill to my insurance and that my private payment services will not factor into my insurance plan’s maximums.
  • I understand that I am not using insurance for these services for testing services wit Vitality Urgent  Care. I freely choose to self-pay for COVID-19 services and understand the associated clinic and partner laboratory testing policies.
  •  If I have insurance coverage and am choosing not to use it, I am aware that there may be other providers who are may be in network with my insurance company, and that if I were to see those providers, some/all of my bill could be covered by insurance benefits.

Clinical Laboratory Services Coordination Disclaimer:

  • Vitality Urgent Care partnered with multiple Clinical Laboratory partners to facilitate COVID 19 RT-PCR testing Services and Results Reporting. Vitality Urgent Care Provides referrals and event coordination but does not have direct ownership in Clinical Laboratory partners.

Consent For Treatment

  • I voluntarily consent to Vitality Urgent and Primary Care (VUPC) and consent to treatment by the nurse practitioner on duty and whomever they may designate as their assistant, associate, collaborating physician, and patient care staff to provide my care.  Such care may include but is not limited to, diagnostic testing and the administration of medications considered advisable in my diagnosis, treatment, and course of care.  I acknowledge that no guarantee can be made or has been made as to the results of treatments or examinations and I understand that all medical treatments contain inherent risks.
  • I am aware that the practice of medicine is not an exact science and I acknowledge that no guarantees have been made to me as to the results of my examination or treatment at VUPC. I acknowledge that treatment at VUPC intended to address specific episodic illnesses or injury and is not intended to substitute for comprehensive care in lieu of a primary care physician or other specialized physicians. In order to provide the best chance for successful treatment, I accept responsibility to follow the advice of my treating provider including compliance with medications, discharge instructions and reevaluation with follow up or referral to specialty care. I agree to seek care in an Emergency Department of a hospital if my condition substantially changes. I further agree to hold harmless the medical providers and staff of VUPC if fail to comply with the above conditions.
  • Patients at VUPC will be treated regardless of race, color, age, national origin, disability or religion. Notwithstanding the above criteria, VUPC reserves the right to refuse care to any individual who may have an unpaid balance, exhibits rude or disruptive behavior or any other reason at the discretion of the physician on duty.

Our commitment to your privacy:

  • Our practice is dedicated to maintaining the privacy of your individually identifiable health information (also called protected health information, or PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.

We may use and disclose your PHI in the following ways:

  • Treatment. Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other healthcare providers for purposes related to your treatment.
  • Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other healthcare providers and entities to assist in their billing and collection efforts.
  • Health care operations. Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your PHI to other healthcare providers and entities to assist in their health care operations.
  • The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

Authorization to release healthcare information and payment guarantee

  • I, the undersigned, authorize the Vitality Urgent and Primary Care to submit claims to my insurance company. I authorize to use and disclosure of my personal information for the purposes of diagnosing or providing treatment to me, obtaining payments for my care, or for the purposes of conducting the health care operations of the practice. I also authorize Vitality Urgent and Primary Care to release any information required in the process of application for financial coverage for the services rendered. This authorization provides that the practice may release objective clinical information related to my diagnoses and treatment, which may be requested by my insurance company or its designated agents.
  • I authorize said payments to be applied to any unpaid balance for which I am responsible.  I understand that I am responsible for and will pay the portion of my bill not covered by insurance companies or third-party payers.  I agree to pay the account in full upon receipt of my billing statement.  If the balance due is referred to a collection agency or attorney, I understand there may be additional fees, interest, or expenses for which I will be responsible. I agree to pay collection costs and reasonable attorney fees incurred in attempting to collect on this amount or any future outstanding account balances. It is our policy that any insurance co-pays and deductibles or any balance of a bill owed by those without insurance is due at the time of service.


  • We may ask to collect secure credit card information prior to the scheduled visit. We’ll only charge your card when you get care from a Vitality Urgent Care provider, and we’ll always let you know beforehand.
  • 1. After your visit, Vitality bills your insurance carrier as an “in-network provider” with appropriate cost codes for service. These codes vary depending on whether you’re a new patient to us or not, and whether a prescription medication was given. (It’s actually a little more complicated than that, but that’s the gist.).
  • 2. Based on your individual plan, your insurance carrier will pay all or some of that claim directly to us. Note – the claims process typically takes about 2-6 weeks, and coverage/reimbursement varies depending on how your employer has structured their plans.
  • 3. If, for some reason, your insurer elects to not cover the full amount, the remaining balance is settled to your account on file. Your insurance carrier will apply this amount to your “in-network deductible”. We’ll always send a detailed statement at least 5 days before settling unreimbursed medical service charges to your account.
  • 4. Vitality Urgent Care will not be submitting a bill to insurance for pre-travel covid testing and that payment service may not factor into my insurance plan’s maximums.
  • Fair & Transparent Pricing
    Our commitment is to fair and transparent pricing. While we can never predict how insurers will treat individual claims, we encourage you to discuss any questions with us. Additionally, we will never charge any patient – insured or not – more than our flat-rate pricing.

Cancellation Policy and No-Show

  • Vitality has made a commitment to you, our patients, to see you as close to your scheduled appointment time as possible. When a patient does not show up for a visit or cancels/reschedules on the day of the appointment, it creates a hole in the schedule that can’t be filled. This is not fair to the patients and practice,
  • Please call us at (224) 601-5001 by at least 24 hours in advance of your scheduled appointment to notify us of any changes /cancellations. You may cancel an appointment online within 24 hours prior to the appointment. If prior notification is not given, you will be charged 50% of the prepaid visit price for the missed appointment.


All content on the website contains general educational information about medical conditions and treatments. The Content on this website should not be considered medical advice and is not intended as medical advice. You agree not to hold us liable for any damages arising from or relating to your reliance on any of the medical information provided on this website. Additionally, you agree not to repeat the medical information that you read on this website to a third party, as that third party may not have read this disclaimer and understood the caveats involved in receiving the information.

If you have questions about this Notice, please contact Vitality Urgent and Primary Care administration for additional details at 224.601.5001 or via email:

Skip the waiting room
and feel better, faster!

Schedule Visit