Consent & Waiver Form

Terms and Conditions

1. Authorization for Use and Disclosure of Information

I authorize Precision Metrics Lab to:

  • Conduct DEXA scans, VO₂ Max tests, and other fitness assessments, understanding that DEXA scans involve low-dose X-rays.

  • Collect, store, and process my personal health and fitness data obtained through assessments or provided by me.

  • Share my anonymized data with research partners or academic institutions for scientific purposes.

  • Use my data to generate personalized reports and recommendations.

  • Retain my data as necessary to fulfill these purposes or as required by law.

  • Use my de-identified information for research, product development, and quality improvement.

I understand I can request information about these uses at any time and may revoke or modify these authorizations in writing.

2. Authorization for Release of Information

I authorize Precision Metrics Lab to use and disclose my health and fitness information for treatment, payment, or healthcare operations if requested by me or a covered entity (e.g., physician, insurance), in compliance with HIPAA if applicable.

I authorize Precision Metrics Lab to send my health and fitness information to me or authorized parties (e.g., healthcare providers) via email, fax, mail, or DexaFit applications.

I understand I can revoke this authorization in writing at any time.

3. Informed Consent for Testing

I understand that DEXA scans, VO₂ Max testing, and related assessments provide body composition and performance-related measurements. DEXA examinations are performed pursuant to authorization by a Pennsylvania-licensed physician and involve the use of low-dose X-ray radiation.

I understand that these assessments are not a substitute for comprehensive medical evaluation, diagnosis, or treatment by a qualified healthcare provider. Any medical concerns or conditions should be discussed with my personal physician.

I have been informed of the nature and purpose of these tests, potential risks (including minimal radiation exposure from DEXA and physical exertion during VO₂ testing), and possible discomforts. I have had the opportunity to ask questions regarding the examination and acknowledge that my questions have been addressed.

3B. DEXA Scan Informed Consent

I understand that the DEXA (dual-energy X-ray absorptiometry) examination involves the use of low-dose X-ray radiation to assess body composition parameters. The estimated effective radiation dose from a whole-body DEXA examination is approximately 0.01–0.03 mSv.

I understand that this examination is performed pursuant to authorization by a Pennsylvania-licensed physician and is conducted in accordance with applicable state regulations governing the use of X-ray equipment.

I acknowledge that DEXA results provide body composition measurements and are not, by themselves, a comprehensive medical evaluation or diagnosis. I understand that any medical concerns or abnormal findings should be discussed with my personal healthcare provider.

I confirm that I am not pregnant and agree to inform staff if there is any possibility of pregnancy prior to the examination.

I have had the opportunity to ask questions regarding the nature of the procedure, its purpose, and associated risks, and all of my questions have been answered to my satisfaction.

3A. VO₂ Max Testing Consent

Purpose and Explanation of the Test:

You will perform a graded exercise test on a motor-driven treadmill or stationary assault bike. The exercise intensity will begin at a low level and increase in stages according to your fitness level. The test may be stopped at any time by the technician due to signs of fatigue, changes in heart rate or blood pressure, or any symptoms you may experience. You may also stop the test at any time for any reason, including fatigue or discomfort.

Attendant Risks and Discomforts:

As with any exercise, there is a possibility of certain changes or adverse events occurring during the test, including but not limited to:

  • Abnormal blood pressure, fainting, dizziness, or shortness of breath

  • Irregular, fast, or slow heart rhythm

  • Muscle strain, sprain, or soreness

  • Slips, trips, or falls from the treadmill or bike

  • In rare cases, heart attack, stroke, or sudden cardiac arrest

Please note that there will not be a physician present on site during the test. You and your physician should evaluate your medical history and current health status to determine whether this test is appropriate for you. Promptly report any unusual sensations such as chest pain, lightheadedness, or shortness of breath to the technician during the test.

Inquiries:

Questions about test procedures or results are encouraged. If you have any concerns, please contact us at support@precisionmetricslab.com before or after your test.

Voluntary Participation & Assumption of Risk:

I acknowledge that I am voluntarily participating in a graded exercise (“VO₂ max”) test conducted by Precision Metrics Lab. I understand that the test involves progressively strenuous physical exertion on a treadmill or stationary assault bike without a physician on site. I understand that inherent risks may include, but are not limited to:

  • Slips, trips, or falls;

  • Muscle or joint injury;

  • Dizziness, fainting, or dehydration;

  • Abnormal cardiovascular responses such as arrhythmia, angina, heart attack, stroke, or sudden death; and

  • Aggravation of preexisting medical conditions.

I freely and knowingly assume all such risks, whether foreseeable or unforeseeable, that may arise from or be connected in any way to my participation in the VO₂ max test.

Release of Liability & Covenant Not to Sue:

To the fullest extent permitted by law, I hereby waive, release, discharge, and covenant not to sue Precision Metrics Lab, its owners, directors, officers, employees, contractors, agents, successors, or assigns (collectively, the “Released Parties”) from any and all claims, demands, actions, damages, or expenses—including attorneys’ fees—arising out of or related to:

  • My participation in the VO₂ max test;

  • Any injury (physical, psychological, or otherwise), illness, or death sustained during or following the test; or

  • The ordinary negligence, acts, or omissions of any of the Released Parties.

This waiver expressly covers—but is not limited to—claims arising from falls, equipment malfunction or misuse, inaccurate results, or delayed emergency response.

Indemnification:

I agree to indemnify and hold harmless the Released Parties from any claim or expense brought by me, my estate, or any third party arising from my participation, except where caused by the Released Parties’ gross negligence or willful misconduct.

Governing Law & Severability:

This section is governed by the laws of the Commonwealth of Pennsylvania. If any portion of this section is found invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Acknowledgment:

I have read, understand, and voluntarily agree to the above VO₂ Max Testing Consent. I certify that I am at least 18 years of age (or have the consent of a parent or legal guardian) and have consulted my physician regarding my suitability for this test.

4. Scope of Services

Services provided by Precision Metrics Lab include body composition and performance-related assessments. DEXA examinations are performed pursuant to authorization by a Pennsylvania-licensed physician in accordance with applicable state radiation regulations.

These services are not a substitute for comprehensive medical evaluation, diagnosis, or treatment by a healthcare provider. Clients are encouraged to consult their personal physician regarding any medical concerns.

5. Radiation Exposure Notice

DEXA examinations involve a very low dose of X-ray radiation (approximately 0.01–0.03 mSv per whole-body scan). All examinations are performed under individual physician authorization and in compliance with applicable Pennsylvania radiation control regulations. Equipment registration, quality assurance, and safety procedures are maintained in accordance with state requirements. Exposure levels are maintained in accordance with the ALARA (As Low As Reasonably Achievable) principle.

6. Medical Oversight

DEXA examinations are conducted under the direction of a Pennsylvania-licensed physician who reviews patient information and authorizes each examination prior to exposure. Repeat DEXA examinations require separate physician authorization prior to exposure.

The supervising physician’s role is limited to review and authorization of examinations in accordance with applicable regulations. Ongoing medical evaluation, diagnosis, and treatment remain the responsibility of the individual’s personal healthcare provider.

7. Assumption of Risk

I understand that participation in body composition and fitness testing involves inherent risks, including but not limited to physical exertion, fatigue, dizziness, or other adverse effects.

I voluntarily assume all risks associated with participation and release Precision Metrics Lab, its owners, staff, agents, and affiliates from liability related to any injury, illness, or adverse outcome that may occur.

8. Emergency Medical Authorization

In the event of a medical emergency during my participation, I authorize Precision Metrics Lab staff to obtain emergency medical treatment on my behalf, including transportation to a medical facility if necessary. I understand that I am responsible for all related costs.

9. Waiver and Release of Liability

I voluntarily participate in Precision Metrics Lab’s services and assume all associated risks. I release and hold harmless Precision Metrics Lab, its owners, staff, agents, and affiliates from any liability for injury, damage, or adverse effects arising from participation, to the fullest extent permitted by law.

10. Limitation of Damages

To the fullest extent permitted by law, Precision Metrics Lab shall not be liable for any indirect, incidental, special, exemplary, or consequential damages, including but not limited to lost profits, lost data, or business interruption, arising from the use of its services, even if advised of the possibility of such damages.

11. Exclusive Remedy

In the event of any claim arising out of or relating to the services provided, the client’s sole and exclusive remedy shall be a refund of the fees paid for the specific service in question. No other remedies or compensations will be available.

12. Indemnification

I agree to indemnify and hold harmless Precision Metrics Lab, its owners, employees, contractors, and affiliates from any and all claims, damages, liabilities, or expenses (including reasonable attorney’s fees) arising out of or related to my participation in its services or any violation of this agreement.

13. No Guarantee of Results

I understand that outcomes from testing and related recommendations may vary. Precision Metrics Lab makes no guarantees, expressed or implied, regarding the accuracy of results or achievement of any particular fitness, health, or performance goals.

14. Force Majeure

Precision Metrics Lab shall not be held liable for any failure or delay in performance due to circumstances beyond its reasonable control, including but not limited to acts of God, weather events, natural disasters, pandemics, labor disputes, governmental orders, or utility disruptions.

15. COVID-19 Liability Waiver

I acknowledge the risk of COVID-19 exposure despite reasonable precautions. I confirm that I am asymptomatic, have not recently been exposed to COVID-19, and agree to follow all applicable health and safety guidelines. I release Precision Metrics Lab from liability related to COVID-19 exposure or transmission.

16. Data Confidentiality and Access

Precision Metrics Lab maintains strict data privacy and security measures to protect client information. I may request a copy of my data in a portable format or request deletion of my data at any time by contacting support@precisionmetricslab.com.

17. Data Retention

Precision Metrics Lab retains client data for up to seven (7) years unless a shorter period is requested in writing, in compliance with applicable laws and regulations.

18. Data Sharing with DexaFit Applications

I expressly grant Precision Metrics Lab permission to share my health and fitness data with DexaFit applications. I understand that this data will be used to provide me with personalized insights, recommendations, and an enhanced user experience within the DexaFit ecosystem.

I acknowledge that once transmitted, this data is subject to DexaFit’s privacy policies and practices, and Precision Metrics Lab is not responsible for how DexaFit or its affiliates manage or secure the data.

I understand that Precision Metrics Lab is a licensee of DexaFit, Inc., and I hereby extend all authorizations, consents, and releases provided in this form to DexaFit, Inc., including any of its subsidiaries.

19. Consent for Marketing Communications

I consent to receive marketing communications from Precision Metrics Lab about products, services, and promotions via email, SMS, or other electronic means. I understand that I can opt out of such communications at any time.

20. Arbitration Agreement

Any dispute arising out of or relating to this agreement or services provided by Precision Metrics Lab shall be resolved by binding arbitration under the rules of the American Arbitration Association, conducted in Allegheny County, Pennsylvania.

By agreeing to arbitration, I waive the right to bring claims in court, including the right to a jury trial.

21. Electronic Records and Signature Consent

I consent to the use of electronic records for communication, storage, and acknowledgment of this agreement. I agree that my electronic signature on this form is legally binding and has the same effect as a handwritten signature.

22. General Provisions

This agreement is governed by the laws of Pennsylvania. If any provision of this agreement is found invalid or unenforceable, the remaining provisions shall remain in full force and effect.

This form is not a substitute for medical advice. Clients should consult with a qualified healthcare provider for any medical concerns.