Phone

020 77 240 540

Whatsapp

+447495970109

E-Mail

info

Address

73 Baker Street

    Specimen Collection Consent Form

    Urine, semen, swabs, stool, hair and other specimen collections

    About Specimen Collection

    Marylebone Diagnostic Centre (MDC) collects and receives specimens for laboratory testing. Depending on the test(s) you have booked, you may be asked to provide one or more specimens, such as urine, semen, a swab, stool or another specimen. You do not need to identify the specimen type on this form. MDC staff will provide the appropriate preparation, hygiene, timing and collection instructions for your booked test(s).

    Specimens must be correctly identified, labelled and suitable for analysis. If a specimen is incomplete, contaminated, incorrectly collected, delayed or otherwise unsuitable, a repeat specimen may be required. Where necessary, specimens may be processed by an approved partner laboratory.

    Potential Risks and Discomforts

    • Urine, semen, stool and self-collected swab specimens are generally low risk, although collection may cause embarrassment or mild discomfort. Incorrect, incomplete or contaminated collection may affect the result and may require a repeat specimen.
    • Clinician-collected swabs can cause brief discomfort and, depending on the collection site, minor spotting or irritation.

    Patient Responsibilities and Choice

    Please follow any preparation and collection instructions provided for your booked test(s), including instructions about abstinence, medication, hygiene, timing or collection technique where relevant. MDC staff will confirm any specimen-specific requirements when needed. Tell MDC staff if instructions were not followed or if anything happened during collection that may affect the specimen. You may ask questions, refuse collection or withdraw consent at any time before or during specimen collection.

    Confidentiality and Use of Your Information and Specimens

    MDC will handle your personal and health information confidentially and in accordance with applicable UK data-protection requirements and MDC's Privacy Notice. Information may be accessed by authorised MDC staff and, where necessary for your laboratory testing, shared securely with the requesting clinician, referral partner or approved laboratory. It may also be disclosed where required by law or where necessary to protect someone from serious harm.

    After your requested laboratory testing has been completed, any remaining specimen that would otherwise be discarded may be used by MDC for research, service evaluation, quality improvement, method development, validation, education or statistical analysis. Before any such use, the specimen will be anonymised so that it cannot be linked back to you. Your name, contact details, patient ID and other direct identifiers will not be attached to the specimen used for these purposes.

    Patient Consent

    • I have read, or had explained to me, the information in this form and have had the opportunity to ask questions.
    • I understand the purpose and nature of the specimen collection required for my booked test(s), including the relevant risks and the possibility that a repeat specimen may be needed.
    • I confirm that the information I have provided is accurate to the best of my knowledge and that any self-collected specimen I provide is my own.
    • I understand that I should tell staff if preparation instructions were not followed or if anything happened during collection that could affect the specimen or result.
    • I understand that I may refuse or withdraw consent at any time before or during specimen collection.
    • I consent to providing, or allowing MDC to collect or receive, the specimen(s) required for the laboratory test(s) I have booked.
    • I understand that any remaining specimen may be used by MDC for the purposes described above after it has been anonymised so that I can no longer be identified from it.

    Patient Declaration and Signature

    If signed by a representative: staff must confirm and record the lawful basis for that person to make the decision. A relative or carer does not automatically have authority to consent on behalf of an adult.

    Marylebone Diagnostic Centre
    Google Maps Apple Maps