Body Scanner consent forms

CONSENT AND DISCLAIMER

Please fill out the following form
in order to participate in our activity.

First name

Last name

Date of Birth

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Initials

During a bone density scan, a type of X-ray called dual energy X-ray absorptiometry is passed through your body. Some radiation is absorbed by the bone and soft tissue, and some travels through your body. Special detectors in the body scanner machine measure how much radiation passes through your bones, and this information is sent to a computer. Your bone density measurements will be compared with the bone density of a young healthy adult or an adult of your own age, gender and ethnicity Despite being very safe, bone density scans and X-rays are not recommended for pregnant women, as X-rays can damage an unborn child. Please remove Jewellery Spectacles Any clothing that interfere with the procedure I hereby acknowledge that I have read information above and understood the process as explained to me by member of staff conducting the scan. I also understand that if I have any health concerns, it is my responsibility to consult with a physician prior to use. I agree not to pursue any legal charges against The Winning Culture for any personal injury or property damage associated with use of the body scanner. I agree that this Application and Waiver is in effect for all far body scan sessions and will not expire unless specifically requested by either party.

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Body Scanner consent forms

CONSENT AND DISCLAIMER

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