PFOA Blood Draw Registration

Thank you for registering for the PFOA Blood Testing Clinic. PFOA blood tests are being offered by the Health Department in response to PFOA contamination of private drinking water in Bennington and North Bennington.

The information collected will be used to:
1. determine your eligibility for blood testing, and
2. help us plan for the upcoming blood test clinic.

Please read the following statements, and then check the box below to show that you understand:

I understand that measuring a person’s blood level of PFOA does not tell whether that person will have a specific health condition or if a condition was caused by PFOA. PFOA is found in the blood of almost all Americans. I understand that my blood will have some level of PFOA, and that if my drinking water is contaminated, my blood PFOA is probably higher than most Americans.
I understand that only those people who have not previously had their blood tested for PFOA by Vermont Department of Health are eligible to participate in this clinic.
I understand that I must sign all the necessary consent forms at the clinic before having my blood drawn and tested for PFOA.
I have spoken with my child’s health care provider about the risks and benefits of this testing and there is no medical reason why my child should not have their blood drawn (if applicable).
The Health Department encourages pregnant women to discuss the risks and benefits of PFOA testing with their health care provider before attending a PFOA blood draw clinic (if applicable).
I understand that for certain medical reasons (e.g. a double mastectomy, severe allergic reaction to latex, etc.), the Health Department may not be able to draw my blood.

*This question is required.

By checking this box, I confirm that I have read and understand the information presented above.