CHAMPION YOUR BODY

Supervised VO2 Max / RMR Test.

• Consent to Treatment: I hereby consent to receive a VO2 Max / RMR Test.
• Contraindications: By signing this form I am indicating that I have no chance of pregnancy, heart conditions or cancer.
• Release of liability: I understand that I’m using the VO2 Max / RMR at my own risk. My results fully depend on my ability to follow protocol and give proper feedback. I release, hold harmless, and indemnify APEX Performance Wellness & Rehab, its owners, agents, employees and representatives, from all liability for any treatment given.
• Release. In consideration for the opportunity to participate in the VO2 Max / RMR, I agree that I, my assignees, heirs, guardians, and legal representatives will not make a claim against Pacific Neuro Therapy LLC or any of their directors, officers, employees, agents, or volunteers for injury, damage, or death resulting from the negligent acts or omissions of any person or entity, however caused, arising from or related to my participation in the VO2 Max / RMR.  I hereby waive and release any rights, actions, or causes of action against Pacific Neuro Therapy LLC resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation in the VO2 Max / RMR.
• Consent to record pictures and videos of your test. These recordings will not be used on social media or website without your further consent and are strictly used for quality assurance, training and feedback. 

Supervised DEXA Scan

• Consent to Treatment: I hereby consent to receive a DEXA Scan.
• Contraindications: By signing this form I am indicating that I have no chance of pregnancy or cancer.
• Release of liability: I understand that I’m using the DEXA Scan at my own risk and acknowledge that the scan will emit light radiation, less than two millirems (less radiation than a cross country flight or daily background exposure). My results fully depend on my ability to follow protocol and give proper feedback. I release, hold harmless, and indemnify DEXA PDX and Pacific Neuro Therapy, its owners, agents, employees and representatives, from all liability for any treatment given.
• This is NOT a diagnostic scan. We are more than happy to send your results to a physician should you have questions regarding your results. DEXA PDX, Pacific Neuro Therapy  and the DEXA scan are simply a tool.
• Release. In consideration for the opportunity to participate in the DexaScan, I agree that I, my assignees, heirs, guardians, and legal representatives will not make a claim against Pacific Neuro Therapy LLC or any of their directors, officers, employees, agents, or volunteers for injury, damage, or death resulting from the negligent acts or omissions of any person or entity, however caused, arising from or related to my participation in the DexaScan.  I hereby waive and release any rights, actions, or causes of action against Pacific Neuro Therapy LLC resulting from personal injury or death to me, or damage to my property, sustained in connection with my participation in the DexaScan.
• Consent to record pictures and videos of your scan. These recordings will not be used on social media or website without your further consent and are strictly used for quality assurance, training and feedback.