Terms and Conditions

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

I provide consent to DexaFit North Jersey and/or DexaFit, Inc. for the use of their DXA scanner to conduct body composition and/or bone densitometry scans, acknowledging the use of low-dose x-rays in the technology.

RECORDS REVIEW FOR RESEARCH

I also grant DexaFit North Jersey and/or DexaFit, Inc. permission to utilize or review my de-identified records for research purposes, and to assess my eligibility for approved clinical studies, allowing them to contact me if I qualify as a research candidate.

ADDITIONAL SERVICES AND TESTING

In conjunction with DXA scans, DexaFit North Jersey and/or DexaFit, Inc. offers a comprehensive suite of services crafted to enhance your wellness journey:

  1. Red Light Therapy: I duly acknowledge the provision of red light therapy services by DexaFit North Jersey and/or DexaFit, Inc. This therapy exposes individuals to low-level wavelengths of light, offering potential holistic benefits. Acknowledging the inherent risks associated with any procedure, I am cognizant that DexaFit North Jersey and/or DexaFit, Inc. is absolved of any liability arising from the practice of red light therapy. Furthermore, I acknowledge that DexaFit is not liable for any damage caused or inaccuracies in the reports resulting from the red light therapy sessions.

  2. 3D Body Scans: As part of its service offerings, DexaFit North Jersey and/or DexaFit, Inc. presents 3D body scans, a cutting-edge technology capturing three-dimensional images for precise body composition analysis. I hereby grant my informed consent for the application of this technology in assessing my body composition. Additionally, I understand and acknowledge that DexaFit is not liable for any inaccuracies in the 3D body scan reports or any consequences arising from following advice based on these reports.

  3. RMR Testing (Resting Metabolic Rate): DexaFit North Jersey and/or DexaFit, Inc. introduces Resting Metabolic Rate testing services, a method for determining the caloric requirements of the body at rest. I willingly provide consent for the administration of this test, recognizing its role in tailoring wellness strategies. I acknowledge that DexaFit is not liable for any inaccuracies in the RMR test reports or any consequences resulting from following advice based on these reports.

  4. Nutrition Counseling: DexaFit North Jersey and/or DexaFit, Inc. provides nutrition counseling services as part of its comprehensive wellness offerings. This service is designed to offer guidance and support for nutritional goals. It is expressly understood and agreed that DexaFit North Jersey and/or DexaFit, Inc. makes no guarantees regarding specific results from nutrition counseling.

    The attainment of nutritional objectives is contingent upon the client's dedication and adherence to recommendations. While DexaFit North Jersey and/or DexaFit, Inc. is committed to delivering professional guidance, individual outcomes may vary based on personal choices and other contributing factors.

    It is explicitly acknowledged that DexaFit North Jersey and/or DexaFit, Inc. bears no liability for outcomes or consequences resulting from nutrition counseling sessions. The client assumes full responsibility for achieving desired nutritional outcomes.

    The client expressly waives any right to bring legal action against DexaFit North Jersey and/or DexaFit, Inc. for poor advice or to hold them legally responsible for any unfavorable outcome arising from nutrition counseling services.

    By engaging in nutrition counseling services, the client affirms a comprehensive understanding of the nature of this offering and unconditionally accepts the stipulated terms.

In appreciation of the comprehensive services offered by DexaFit North Jersey and/or DexaFit, Inc., I embrace these offerings with confidence in the commitment to client well-being. I understand the nature of each service and acknowledge the terms outlined herein.

FINANCIAL RESPONSIBILITY:

I hereby acknowledge and assume full financial responsibility for all charges related to the services provided to myself, my family members, and/or my responsible parties at DexaFit North Jersey. I understand and agree that all payments are non-refundable, and I explicitly waive any right to dispute transactions.

In the event of a cancellation within a 24-hour period preceding the scheduled appointment, I acknowledge that no refunds will be issued. Additionally, I commit to paying a $50 rescheduling fee for any changes made within a 24-hour timeframe from the scheduled appointment. There will be no refund issued for no-show appointments. Furthermore, no refund will be issued if any test part of a bundle is rescheduled and subsequently canceled. I agree and acknowledge that appointments made for special events can not be rescheduled to another day.

Furthermore, I recognize that should I choose to reschedule within 24 hours of the appointment and subsequently cancel, I am obligated to pay the complete value of the service along with an additional rebooking fee.

DexaFit NJ Unlimited and Live Well Subscription Terms:

I understand that the DexaFit NJ Unlimited/Live Well Subscription is for the exclusive use of one person only, the subscriber. In the event that the subscription is used by someone other than the subscriber, I agree to pay a minimum fee of $500, up to the cost of individually booked, daily Red Light Therapy sessions, 3D Body Scans, or DEXA Body Composition Scans for one year, at the discretion of DexaFit North Jersey. I explicitly waive any right to dispute this charge in court or with credit card processing companies or any other institution.

I understand that cancellations require a 30-day notice. If my renewal date passes after the 30-day notice period, I acknowledge and agree that I will be charged for one more subscription period.

DexaFit NJ Nutrition Counseling Terms:

I acknowledge and understand eligibility for HSA/FSA reimbursement for nutrition counseling is contingent upon obtaining a Letter of Medical Necessity from a Primary Care Physician (PCP). DexaFit North Jersey is not responsible for the reimbursement process. I understand I must consult with my HSA/FSA administrator for specific guidelines and procedures for my specific plan terms.

DexaFit North Jersey and/or DexaFit, Inc. provides nutrition counseling services available in both single-session purchases and subscription-based plans operating on a 4-week billing cycle, as part of its comprehensive wellness offerings.

Single Sessions: For single-session purchases, it is expressly understood and agreed that all sales are final, and no refunds will be accepted, regardless of whether the client utilizes the service.

Subscription-Based Services: For subscription-based plans, clients commit to a 4-week billing cycle upon enrollment. All sales for the 4-week subscription cycle are final, and no refunds will be accepted once the billing period commences. In the event of a cancellation within the 4-week billing period, the client is not entitled to a refund, and the full financial obligation for the current cycle remains in effect. The subscription will renew unless canceled by the client. It is acknowledged that this is the client's responsibility and not that of DexaFit North Jersey and/or DexaFit, Inc.

I acknowledge and understand eligibility for HSA/FSA reimbursement for all programs is program-specific and that I must contact my HSA/FSA plan administrator for specific guidelines and procedures for my specific plan terms.

By accepting these terms, I affirm my dedication to meeting the financial obligations associated with the services provided.

WAIVER AND AGREEMENT

  1. I release all representatives of DexaFit North Jersey and/or DexaFit, Inc. from any responsibility or liability for injury or damage to myself, including those caused by the negligent acts or omissions of those mentioned or others acting on their behalf, arising out of or connected with my participation in services, activities, or programs of DexaFit North Jersey and/or DexaFit, Inc.

  2. I am voluntarily participating in the DexaFit North Jersey and/or DexaFit, Inc DXA scan service and/or other services, including 3D scans, RMR and VO2max Metabolic Analysis, Red Light Therapy, Training Programs, and nutritional/meal planning consultation, and all other services performed by DexaFit North Jersey. I expressly assume all risks of injury and death resulting from participation in the aforementioned services.

  3. I declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that disqualifies me from receiving a DXA scan from DexaFit North Jersey and/or DexaFit, Inc. I acknowledge that I have permission to participate or have decided to participate in these services without the approval of my physician, assuming all responsibility for my participation. I also certify that I am not pregnant or trying to become pregnant.

  4. I take full responsibility for any action taken by me after my visit to DexaFit North Jersey and/or DexaFit, Inc. I do not hold any representatives of DexaFit North Jersey or DexaFit, Inc responsible or liable for any adverse effects or complications arising from the services or opinions offered by them.

  5. Confidentiality: Information based on the observations made during the DXA scan, VO2max, or RMR analysis, and subsequent reports are treated as privileged and confidential. However, it may be used for statistical or scientific purposes while retaining your right to privacy.

  6. I understand that DexaFit North Jersey and/or DexaFit, Inc does not diagnose or interpret the DXA results, and that any further review or analysis of the report is between the individual and their primary care physician.

CLIENT HIPAA CONSENT FORM

I understand that I have certain rights to privacy regarding my protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). By signing this consent, I authorize DexaFit North Jersey and/or DexaFit, Inc to use and disclose my protected health information to carry out:

  • Treatment (including direct or indirect treatment by other healthcare providers involved in my treatment)

  • Obtaining payment from third-party payers (e.g. my insurance company)

  • The day-to-day operations of DexaFit North Jersey practice.

I understand that I have the right to request restrictions on how my protected health information is used and disclosed to carry out treatment, payment, and health care operations, but that DexaFit is not required to agree to these requested restrictions. If agreed, DexaFit is bound to comply with these restrictions.

I may revoke this consent in writing at any time, but any use or disclosure before the date of revocation is not affected.

AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION

I authorize DexaFit North Jersey and/or DexaFit, Inc to forward the health and fitness information resulting from their services to me or any parties authorized by me through email, fax, mail, or the private login page on the DexaFit website. This Authorization is subject to revocation/withdrawal in writing by me to DexaFit North Jersey, except for actions already taken to release this information. This Authorization shall remain valid unless revoked, and DexaFit North Jersey and/or DexaFit, Inc will not forward my health and fitness information if I do not consent to this Authorization.

I attest that I am NOT pregnant and 350 pounds and have read and agreed to the above, consenting to participate in the services rendered by Dexafit North Jersey.

Consent Form for VO2max:

  1. Purpose and Explanation for the Test:

    • You will perform a graded exercise test on a motor-driven treadmill or stationary bike. The exercise intensity will begin at a low level and advance in stages, depending on your fitness level. The test may be stopped at any time due to signs of fatigue, changes in heart rate or blood pressure, or any symptoms you may experience. You may stop the test at any time due to feelings of fatigue or discomfort.

  2. Attendant Risks and Discomforts:

    • As with any exercise, there exists the possibility of certain changes occurring during the test, including abnormal blood pressure, fainting, irregular, fast, or slow heart rhythm, and, in rare instances, heart attack, stroke, or death. Please note that there will NOT be a physician present on-site.

    • You and your own Doctor should evaluate the information you possess about your health status or previous experience with exercise-related or heart-related symptoms (such as shortness of breath with low-level physical activity, pain, pressure, tightness, or heaviness in the chest, neck, jaw, back, and/or arms) that may affect the safety of your test. Your prompt reporting of these and any other unusual feelings during the test is of great importance. You are responsible for consulting with your own doctors before taking the test.

  3. Inquiries

    • Any questions about the procedures used in the exercise test or the results of your test are encouraged. If you have any concerns or questions, feel free to ask via email at support@dexafitnj.com prior to the test.

I hereby consent to engage in an exercise test to determine my exercise capacity. My permission to perform this test is given voluntarily. I understand that I may stop the test at any point if I so desire. I have read this form and understand the test procedures I will perform and the attendant risks and discomforts. I understand that there will NOT be a supervising physician onsite. Knowing these risks and discomforts, and having had an opportunity to ask questions that have been answered, I consent to participate in the test.

Referral Program

  1. The referral program applies only to new client bookings.

  2. Referral codes must be entered at the time of booking to be valid.

  3. Clients cannot cancel an existing appointment and rebook using a referral code. Doing so will result in the forfeiture of the referral prize, and no refund will be provided for the initial appointment.

  4. The referral prize (complimentary DexaFit Body Scan) is awarded only after successfully referring 5 individuals who complete their bookings.

  5. If a client cancels their appointment, they forfeit the referral prize, even if the required referrals have been achieved.

  6. Referral codes are unique to each client and are based on their phone number without punctuation.

  7. DexaFit North Jersey reserves the right to modify or terminate the referral program at any time.

  8. The referral prize has no cash value and is non-transferable.

  9. DexaFit North Jersey is not responsible for any technical issues or delays in the referral tracking system.

  10. Limit 4 free scans per year

  11. Other terms and conditions may apply. Please contact DexaFit North Jersey for any further clarification.

By participating in the DexaFit North Jersey Referral Program, clients agree to abide by these terms and conditions. DexaFit North Jersey reserves the right to interpret these rules and make decisions at its discretion.