Terms and Conditions

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

I consent to allow [ENTER LLC NAME], LLC, DBA DexaFit Orlando, to use their DXA scanner to perform a body composition and/or bone densitometry scan, with full awareness that the technology uses low-dose X-rays. The bone densitometry scan is Tech Only, is not read by a radiologist at DexaFit, and will not be reviewed with the client.

RECORDS REVIEW FOR RESEARCH

I also authorize [ENTER LLC NAME], LLC, DBA DexaFit Orlando, to review my records to determine whether my body scan qualifies for approved clinical studies and to contact me if I am a potential candidate for research. No records will be shared with any third parties for research purposes unless I provide specific written approval.

FINANCIAL RESPONSIBILITY

I accept full financial responsibility for all charges for services provided to me and/or my family members. I verify that I am the cardholder and authorize [ENTER LLC NAME], LLC, DBA DexaFit Orlando, to charge the card on file in my account for purchases, no-show fees, and late cancellation or rescheduling fees.

If [ENTER LLC NAME], LLC, DBA DexaFit Orlando, is unable to charge the card on file, any applicable fees must be paid immediately and may be subject to collections if unpaid. Fees must be paid before any future service appointments will be honored.

• No refunds on tests rendered.

• All packages expire 12 months from the date of purchase.

• No refunds or partial refunds on unused tests from purchased packages.

• Tests do not roll over year to year.

• Clients will not receive reminders about unused tests.

• No extensions will be granted on packages.

Voucher codes, gift cards, or discount codes must be applied at the time of scheduling. If you have issues applying a code, please contact us at (971) 245-4010. If payment has already been made in full, we cannot issue a refund to retroactively apply a voucher, gift card, or discount code. However, these may be used toward your next appointment.

We accept HSA/FSA cards, but it is the client's responsibility to verify coverage. We can provide an itemized receipt upon request for reimbursement.

FACILITY POLICY

Guests, children, or pets are not allowed at your appointment. Due to radiation safety concerns, the comfort of other clients, and our goal of maintaining a distraction-free environment, guests, children, or pets will be asked to leave upon arrival—no exceptions. If necessary, the appointment will be canceled or rescheduled, and a late cancellation fee will apply. If two clients are scheduled back-to-back, they may enter together.

CANCELLATION / LATE ARRIVAL POLICY

DexaFit Orlando is an appointment-based office. If you are unable to attend your appointment, please notify us at least 24 hours in advance so that others may utilize the time slot.

• Arrivals more than 10 minutes late may result in rescheduling to avoid disruption, and a late cancellation fee will apply.

• If you are more than 10 minutes late without notifying DexaFit Orlando, your appointment will be canceled.

• If you arrive unprepared for a test or decide not to proceed with a scheduled test, a late cancel fee will apply for that test.

Late Cancellation or No-Show Fee:
If you cancel, reschedule within 24 hours, or fail to show up, you will be charged $75 per test scheduled, regardless of when the appointment was booked.

For prepaid appointments or packages: the $75 late cancel/no-show fee will be deducted from the prepayment. The remaining credit can be used toward your next visit, or the missed test will be deducted from the package. No partial refunds.

WAIVER AND AGREEMENT

1. I hereby release all representatives of [ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc., including those acting on their behalf, from any responsibility or liability for injury or damages to myself, including those caused by negligence or omission, arising out of participation in any services or programs.

2. I am voluntarily participating in services provided by [ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc., including but not limited to DXA scans, RMR Metabolic Analysis, and VO2 Max testing. I assume all risks of injury or death resulting from these services.

3. I declare that I am physically sound and have no condition that prevents me from receiving services from [ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc. I confirm that I have either obtained my physician’s approval or assume responsibility for proceeding without it. I also certify that I am not pregnant or attempting to become pregnant.

4. I accept full responsibility for any actions I take after receiving services and do not hold [ENTER LLC NAME], LLC, DBA DexaFit Orlando, or DexaFit, Inc. responsible for any adverse effects or complications.

5. I understand that data obtained during my scan(s) and analysis is considered confidential and will be treated as such. It may only be used for statistical or scientific purposes, with my privacy rights fully retained.

6. I understand that [ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc. does not diagnose or interpret DXA scan results. Any follow-up analysis should be reviewed with my primary care physician.

CLIENT HIPAA CONSENT FORM

I understand that I have rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding my protected health information. By signing this consent, I authorize [ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc. to use and disclose my health information for:

• Treatment (including coordination with other healthcare providers),

• Obtaining payment from third-party payers (e.g., insurance companies),

• Operational purposes of the practice.

I understand I may request restrictions on how my information is used. While DexaFit is not required to agree to my requested restrictions, if it does, it will be bound by that agreement.

I understand that I may revoke this consent in writing at any time, but that any prior uses or disclosures are not affected by the revocation.

AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION

I authorize [ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc. to release my health and fitness information to myself or parties I authorize via email, fax, mail, or through the private login on the DexaFit website.

I understand this authorization may be revoked at any time in writing by contacting info.orlando@dexafit.com, except where actions have already been taken based on the current authorization. This authorization remains valid unless revoked.

[ENTER LLC NAME], LLC, DBA DexaFit Orlando, and/or DexaFit, Inc. will not share my information without this authorization.