Please read the following carefully. By signing below, I hereby acknowledge and agree that I have fully read this Informed Consent and Release of Liability ("Consent and Release"), that I have had the opportunity to ask questions regarding the Echolight Ultrasound Scan that BoneVue Diagnostics LLC will perform on me ("BoneVue Diagnostics"), and that I have sufficient information to give my informed consent and agree to the waiver and release of liability set forth below.
About the Echolight Ultrasound Scan:
The Echolight is a modern ultrasound device that uses an innovative bone health monitoring technology called REMS (Radiofrequency Echographic Multi Spectrometry) to assess bone density, evaluate bone strength and fracture risk and/or body muscle composition. (the "Bone Composition Scan" or the "Scan") The REMS technology uses safe ultrasound waves to accurately measure bone mineral density (BMD), providing comprehensive clinical data including BMD, T-score, and Z-score, Fragility Score and body muscle composition. The Bone Composition Scan is quick and radiation-free.
During the Scan, you will be comfortably positioned lying flat on your back (face up) on an examination table to ensure relaxation. Our technician will use the Echolight ultrasound device to gently scan the targeted areas of your bones. This process is radiation-free, taking only 15-20 minutes.
The Echolight ultrasound scan is for information purposes only and should not be considered medical advice or a replacement for advice from a physician or healthcare professional. You should consult with your healthcare provider for any specific health concerns based on your scan.
Consent To Receive Echolight Ultrasound Scan:
I understand that my skin will be exposed during Echolight ultrasound scan and that my privacy and modesty will be maintained as much as reasonably possible considering the scan performed. I will immediately inform the technician if at any time I feel uncomfortable or any pain or discomfort during the scan. I understand that I am not a patient of BoneVue Diagnostics. I acknowledge that the BoneVue Diagnostic technician performing my ultrasound is not a trained medical physician and cannot provide medical findings or diagnosis at any time before, during, or after my ultrasound scan session. I further state that there are no health-related reasons or problems which preclude or restrict my participation in the Echolight ultrasound scan.
Consent To Use of My Information:
I hereby consent to BoneVue Diagnostics using my Personal information, scan and report in de-identified form only for research, development, quality assessment, and other related business purposes, provided, however, that BoneVue Diagnostics will not provide my personal information, scan, or report to any third party without my prior, written consent.
Waiver and Release of Liability:
On behalf of myself, my family, heirs, and personal representative(s), I release, waive, forever discharge, covenant not to sue, and hold harmless BoneVue Diagnostics and its officers, directors, employees, technicians, and agents ("Releasees"), from and against any and all claims, demands, damages, actions, or causes of action, whether foreseen or unforeseen, resulting from the Echolight ultrasound scan performed by BoneVue Diagnostics, including, without limitation, any injury, loss, or damage that may be sustained by me or by any property belonging to me, or any future diagnostic concern or treatment that may arise from the scan and/or the results thereof.
