Thank you for reviewing the information below in regards to testing for your DEXA scan and/or Resting Metabolic Rate (RMR) test, and signing this form (see the bottom of the page).
Best wishes,
Omar Sultan Haque, M.D., Ph.D.
Medical Director
1101 Beacon Street, Suite 8-West
Brookline, MA 02446
617-221-8433 (phone)
844-733-6150 (fax)
I hereby consent to engage voluntarily in DEXA (Dual Energy X-Ray Absorptiometry) scan testing and/or Resting Metabolic Rate (RMR) testing at 1101 Beacon Street, Suite 8W, Brookline, MA 02446. I understand the following information and agree to its guidelines described below:
-A DEXA scan is a radiological test that uses X-rays to measure the amount of X-rays absorbed by different tissues in the body, and can thereby create an image of one’s body and measure body composition.
-Testing is an appropriate tool for:
-Measurement beyond the limitations of Body Mass Index (BMI)
-Measurement beyond the limitations of the scale (absolute weight amount).
-Determination of body composition, specifically, amount of visceral adipose tissue (VAT), and percent muscle vs. adipose tissue.
-Determination of bone mineral density, osteoporosis risk/progression/monitoring, and fracture risk.
-Helping to inform clinical treatment planning in light of the above information to optimize health, wellness, longevity, and minimize cardiovascular disease risks and mortality.
-Baseline measurement, and future tracking of progress in a medically supervised weight loss program
-A DEXA scan is a radiological test that uses X-rays to measure the amount of X-rays absorbed by different tissues in the body, and can thereby create an image of one’s body and measure body composition.
-Testing is an appropriate tool for:
-Measurement beyond the limitations of Body Mass Index (BMI)
-Measurement beyond the limitations of the scale (absolute weight amount).
-Determination of body composition, specifically, amount of visceral adipose tissue (VAT), and percent muscle vs. adipose tissue.
-Determination of bone mineral density, osteoporosis risk/progression/monitoring, and fracture risk.
-Helping to inform clinical treatment planning in light of the above information to optimize health, wellness, longevity, and minimize cardiovascular disease risks and mortality.
-Baseline measurement, and future tracking of progress in a medically supervised weight loss program
-A DEXA scan is a radiological test that uses X-rays to measure the amount of X-rays absorbed by different tissues in the body, and can thereby create an image of one’s body and measure body composition.
-Testing is an appropriate tool for:
-Measurement beyond the limitations of Body Mass Index (BMI)
-Measurement beyond the limitations of the scale (absolute weight amount).
-Determination of body composition, specifically, amount of visceral adipose tissue (VAT), and percent muscle vs. adipose tissue.
-Determination of bone mineral density, osteoporosis risk/progression/monitoring, and fracture risk.
-Helping to inform clinical treatment planning in light of the above information to optimize health, wellness, longevity, and minimize cardiovascular disease risks and mortality.
-Baseline measurement, and future tracking of progress in a medically supervised weight loss program
-A DEXA scan is a radiological test that uses X-rays to measure the amount of X-rays absorbed by different tissues in the body, and can thereby create an image of one’s body and measure body composition.
-Testing is an appropriate tool for:
-Measurement beyond the limitations of Body Mass Index (BMI)
-Measurement beyond the limitations of the scale (absolute weight amount).
-Determination of body composition, specifically, amount of visceral adipose tissue (VAT), and percent muscle vs. adipose tissue.
-Determination of bone mineral density, osteoporosis risk/progression/monitoring, and fracture risk.
-Helping to inform clinical treatment planning in light of the above information to optimize health, wellness, longevity, and minimize cardiovascular disease risks and mortality.
-Baseline measurement, and future tracking of progress in a medically supervised weight loss program
-A DEXA scan is a radiological test that uses X-rays to measure the amount of X-rays absorbed by different tissues in the body, and can thereby create an image of one’s body and measure body composition.
-Testing is an appropriate tool for:
-Measurement beyond the limitations of Body Mass Index (BMI)
-Measurement beyond the limitations of the scale (absolute weight amount).
-Determination of body composition, specifically, amount of visceral adipose tissue (VAT), and percent muscle vs. adipose tissue.
-Determination of bone mineral density, osteoporosis risk/progression/monitoring, and fracture risk.
-Helping to inform clinical treatment planning in light of the above information to optimize health, wellness, longevity, and minimize cardiovascular disease risks and mortality.
-Baseline measurement, and future tracking of progress in a medically supervised weight loss program
-A DEXA scan is a radiological test that uses X-rays to measure the amount of X-rays absorbed by different tissues in the body, and can thereby create an image of one’s body and measure body composition.
-Testing is an appropriate tool for:
-Measurement beyond the limitations of Body Mass Index (BMI)
-Measurement beyond the limitations of the scale (absolute weight amount).
-Determination of body composition, specifically, amount of visceral adipose tissue (VAT), and percent muscle vs. adipose tissue.
-Determination of bone mineral density, osteoporosis risk/progression/monitoring, and fracture risk.
-Helping to inform clinical treatment planning in light of the above information to optimize health, wellness, longevity, and minimize cardiovascular disease risks and mortality.
-Baseline measurement, and future tracking of progress in a medically supervised weight loss program
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.
