top of page

Phlebotomy Board Prep & Clinical Skills Agreement

EMS Proficient Mobile Phlebotomy Service LLC

Office Line: (813) 733-7126| Email: skills@emsphlebotomy.org

SECTION 1. PARTICIPANT INFORMATION & CORE DISCLOSURE

I understand that EMS Proficient Mobile Phlebotomy Service LLC is a commercial mobile specimen collection company and clinical laboratory service provider, not a postsecondary vacational school or academy.

Date of Birth
Month
Day
Year

SECTION 2. SCOPE OF EXAM PREP SERVICES PROVIDED

The Provider operates an independent, mobile, CLIA-waived laboratory enviroment. Under this agreement, the Provider will supply:


  • Access to temporatory clinical pop-up spaces and all necessary clinical blood collection materials.

  • Direct clinical proctoring by an NPCE Certified Phlebotomy Instructor.

  • Instructional board examination review materials covering essential phlebotomy theory.

  • Direct hands-on supervision to execute and log the 30 mandatory successful venipunctures and 10 capillary sticks required for national certification.

  • Official signature validation documentating the Participant's successfully completed clinical counts for submission to NPCE.

Service Selection

SECTION 3. FLORIDA DEPARTMENT OF EDUCATION MANDATORY DISCLAMIMER

  • Not a Licensed Career College: EMS Proficient Mobile Phlebotomy Service LLC provides professional development and examination preparation services under Florida Statute 1005.06(1)(d). We are not a licensed vocational school, career college, or postsecondary educational institution and are not regulated by the Florida Department of Education or the Commission for Independent Education (CIE).


  • No Diploma or Degrees: Our curriculum is strictly an independent board review program designed to prepare students for the National Phlebotomy Certification Examination (NPCE).We do not award vocational diplomas, academic degrees, or institutional career graduate certificates.


  • Certification Independence: Participants will receive a Certificate of Skills Completion upon finishing the session strictly to verify their clinical logs. The Provider does not guarantee that the Participant will pass the national board exam or secure employment.

SECTION 4. FEES, PAYMENT, AND ALLOCATION AGREEMENT

  • Flat Clinical Lab Access Fee:$600.00

  • Fee Structure & Allocation Agreement

  • Partner National Examination Packet Fee:$200.00 (Optional)

I varify that all fees paid under this agreement are strictly allocated towards professional board examination preparation materials, classroom workplace rental, clinical lab access, instructional coaching, and laboratory consumable supplies.

  • Refund Policy: All fees paid are for laboratory station allocation, material overhead, and instructor time.


  • Cancellations made more than 48 hours prior to scheduled sessions will receive a 100% refund.


  • Cancellations made less than 48 hours in advance are non-refundable but may be rescheduled once at the discretion of the Provider for a rescheduling fee of $100.00.


  • Once the session begins, no refunds will be issued under any circumstances.

SECTION 5. CLINICAL SAFETY, DRESS CODE, AND DISMISSAL

  • Safety Assurance:

    I agree to follow all OSHA, CLIA, and laboratory safety protocols directed by the on-site instructor and hosted venue staff.


  • Clinical Model Requirements: The clinical skills verification process require a minimum of 30 successful venipunctures and 10 capillary sticks on live individuals. Participants acknowledges that they share the responsibilty of recruiting volunteer models (friends, family, or peers) to attend their scheduled regional pop-up session.


  • Dress Code: Participants must arrive in solid-colored scrubs, completely closed-toe shoes (no clogs, crocks, or mish shoes), an have long hair securely tied back.


  • Behavior and Dismissal: The instructor reserves the right to immediately terminate a session and permanently dismiss any Participant from the venue without a fefund if the Participant demonstrates reckless behavior or violates safety protocols.

SECTION 6. LIABILITY WAIVER AND RELEASE

SECTION 8. LEGAL DISSCLOSURES

Please read: By checking the boxes below, I acknowledge that my electronic signature and initials signifies my complete understanding of, and absolute agreement with, all of the terms and legal disclosures outlined in the document below.

Educational Status & Board Review Disclaimer

EMS Proficient Mobile Phlebotomy Service LLC provides professional developmnt and examination preparation services under Florida Statute 1005.06(1)(d). We are a mobile healthcare services provider and are not a licensed vocational school, career college, or postsecondary educational institution, and we are not regulated by the Florida Department of Education for the Commission for Independent Education (CIE).


Our workshops, seminars, and phlebotomy examination preparation courses are strictly independent board review programs designed to prepare students for the National Phlebotomy Certification Examination (NPCE). They are entirely avocational, designed solely for professional development and individual skill enhancement. We do not offer or award academic degrees, vocational diplomas, or career placement services. All fees are paid exclusively for examination review materials, consumable laboratory supplies, and instructor-led clinical skill validation. Participants will receive a Certificate of Skills Completion upon finishing the session to verify their clinical logs.

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

bottom of page