The account named above will hold all necessary patient signatures on file at the practice for
samples sent to Mako Medical Laboratories LLC and its affiliates or subsiduaries. Mako Medical Laboratories is not required to have these signatures. The account recognizes that it is their responsibility to obtain patient signatures at the time of initial sample collection and keep signatures up to date. Additionally, the account recognizes that Mako Medical Laboratories has the right to obtain a copy of patient signatures held on file at any time.

The account understands that this will remain in effect until changed by the undersigned