ELECTRONIC SIGNATURE

With my electronic signature below, I indicate that I have read this form, and I understand the test(s) procedures, possible benefits, and possible risks that I will undertake, and all information described above, and agree to this form’s content and guidelines, and consent to undertake a DEXA scan and/or Resting Metabolic Rate (RMR) testing at 1101 Beacon Street, Suite 8W, Brookline, MA 02446. If I have any questions or clarifications, I will ask them to my clinician before my test and/or to the staff performing my test. Knowing the test’s process, nature, possible benefits and possible risks, I consent to participate.

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By clicking the “Consent” button below, I electronically sign this form, and indicate that I have read, understand, and agree to its Terms and Conditions content.

Our specialized tests are not covered by insurance, and no insurance claims should be filed by us, you, or any third party, and no out of network benefits apply to the services for DEXA and/or RMR at our clinic