Informed Consent
Please read this entire Informed Consent document ("Informed Consent") before you sign it. If there is anything that is unclear to you, please ask questions before you sign. You may reach us at info@nomadfitlab.com if you have questions about this Informed Consent document.
Agreement:
The purpose of this document is to verify that you have received and understand the information contained in this document and that you have given your consent to receive a DXA scan ("Scan") and information related to the results of the Scan (collectively, the "Services") from Nomad Fit Lab.
The Scan involves a low dose of X-rays. You should not receive the Scan if: ( The "Negative Indicators" )
- *You are pregnant or there is a chance that you are pregnant.
- *You have had a barium X-ray in the last two (2) weeks.
- *You have had a nuclear medicine scan or injection of X-ray dye in the last week.
By signing this Informed Consent, you represent that none of the Negative Indicators apply to you and that you consent to receive the low dose X-ray Scan.
Nomad Fit Lab is not a healthcare provider. Nomad Fit Lab will only provide a general explanation of the kinds of information provided in the written reports by an individual with general knowledge about wellness, fitness, and nutrition and an individual certified to perform the Scan.
Nomad Fit Lab will not provide medical advice and will not provide any diagnosis, treatment, operation or prescription for any illness or ailment.
After you receive the Services, it will be your decision whether or not to utilize the information provided to you for any purpose. The Services, including all communications by Nomad Fit Lab, are not intended to be, and shall not constitute or be deemed to be, medical advice, and shall not constitute a recommendation or endorsement of any specific person or organization. If you desire or need medical advice or treatment, you must see your own physician or other healthcare provider.
Assumption of Risk:
In consideration for being allowed to Scan, I agree to assume the risk of such testing. I further agree to hold harmless Nomad Fit Lab, its staff members, and its affiliates who supervise the Scan from any and all claims, suits, losses or related causes of action for damages, including, but not limited to, such claims that may result from the injury or death, accidental or otherwise, during or arising in any way from the Scan at Nomad Fit Lab.
By signing below, I acknowledge and agree that:
- *I have read and understand everything set forth in this Informed Consent agreement
- *I understand and acknowledge that neither Nomad Fit Lab, nor any employee or representative of Nomad Fit Lab, undertakes to monitor or supervise my health
- *If I need individual medical advice or treatment, I will go to my own physician or healthcare provider for that advice or treatment
- *I have had a full opportunity to ask questions about the scope and content of the Scan
- *I can fully participate in and receive the Scan without limitation
- *I authorize the Scan, voluntarily elect to participate in and receive the Scan, and accept the Scan under the conditions described in this Informed Consent
- *I assume all risk of personal injury, illness and/or death arising out of or resulting from the Scan
Disclosure:
Nomad Fit Lab may use client results as anonymous data points for research purposes. Nomad Fit Lab may study client data in aggregate, in order to examine trends and patterns, and may publish anonymized, aggregated findings via the Nomad Fit Lab website or other written reports. Nomad Fit Lab will NEVER release any client's personal individual data or reveal any identifying information about client scan results without the client’s explicit written permission.
Please speak to a Nomad Fit Lab staff member if you have questions.
Signature
Draw your signature in the box below
