Terms and Conditions.

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

I provide consent to OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (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 OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (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, OptimizeMD LLC dba DexaFit Cincinnati offers a comprehensive suite of services crafted to enhance your wellness journey:

  1. RMR Test

    OptimizeMD LLC dba DexaFit Cincinnati provides Resting Metabolic Rate (RMR) testing services to determine the body’s caloric requirements at rest. By participating in this test, I voluntarily consent to its administration and acknowledge its role in informing and tailoring wellness strategies. I understand that OptimizeMD LLC dba DexaFit Cincinnati, along with its business associate (DexaFit, Inc.), is not responsible for any inaccuracies in the RMR test results or for any consequences arising from actions taken based on these results.

    The success of nutritional or wellness objectives depends on the client’s commitment to utilizing the information provided through the RMR test. OptimizeMD LLC dba DexaFit Cincinnati and its business associate (DexaFit, Inc.) provide this testing solely for informational purposes. No professional guidance or recommendations are offered unless the client engages in a formal doctor-patient relationship with Dr. David J. DeMarco, MD, under a separate agreement that includes applicable fees. It is further acknowledged that any such services will not be billed to insurance, and clients are solely responsible for payment. Individual outcomes may vary due to personal choices, lifestyle factors, and other external circumstances.

    It is explicitly acknowledged that OptimizeMD LLC dba DexaFit Cincinnati and its business associate (DexaFit, Inc.) are not liable for any outcomes or consequences resulting from the client’s use of the test results. Clients are strongly encouraged to share their RMR test findings with their primary care provider or another qualified healthcare professional for further evaluation and integration into their broader health plan. The client assumes full responsibility for utilizing the test results and achieving their desired nutritional and wellness outcomes.

  2. VO2max

    OptimizeMD LLC dba DexaFit Cincinnati provides VO2 Max testing services to assess the body’s maximum capacity for oxygen utilization during exercise. By participating in this test, I voluntarily consent to its administration and acknowledge its role in informing and optimizing fitness strategies. I understand that OptimizeMD LLC dba DexaFit Cincinnati, along with its business associate (DexaFit, Inc.), is not responsible for any inaccuracies in the VO2 Max test results or for any consequences arising from actions taken based on these results.

    The success of fitness or wellness objectives depends on the client’s commitment to utilizing the information provided through the VO2 Max test. OptimizeMD LLC dba DexaFit Cincinnati and its business associate (DexaFit, Inc.) provide this testing solely for informational purposes. No professional guidance or recommendations are offered unless the client engages in a formal doctor-patient relationship with Dr. David J. DeMarco, MD, under a separate agreement that includes applicable fees. It is further acknowledged that any such services will not be billed to insurance, and clients are solely responsible for payment. Individual outcomes may vary due to personal choices, lifestyle factors, and other external circumstances.

    It is explicitly acknowledged that OptimizeMD LLC dba DexaFit Cincinnati and its business associate (DexaFit, Inc.) are not liable for any outcomes or consequences resulting from the client’s use of the test results. Clients are strongly encouraged to share their VO2 Max test findings with their primary care provider or another qualified healthcare professional for further evaluation and integration into their broader fitness or health plan. The client assumes full responsibility for utilizing the test results and achieving their desired fitness and wellness outcomes.

In appreciation of the comprehensive services offered by OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (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 OptimizeMD LLC dba DexaFit Cincinnati 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.

WAIVER AND AGREEMENT

  1. I release all representatives of OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (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 OptimizeMD LLC dba DexaFit Cincinnati.

  2. I am voluntarily participating in the OptimizeMD LLC dba DexaFit Cincinnati DXA scan service and/or other services, including RMR and VO2max Metabolic Analysis, and all other services performed by OptimizeMD LLC dba DexaFit Cincinnati. 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 OptimizeMD LLC dba DexaFit Cincinnati. I acknowledge that I have permission to participate or have decided to participate in these services without the approval of my physician, personally assuming all responsibility for my participation. I also certify that I am not pregnant or trying to become pregnant. If I am not sure if I am pregnant, I will allow OptimizeMD LLC dba DexaFit Cincinnati to perform a urine pregnancy test.

  4. I take full responsibility for any action taken by me after my visit to OptimizeMD LLC dba DexaFit Cincinnati. I do not hold any representatives of OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (DexaFit, Inc) responsible or liable for any adverse effects or complications arising from the services 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 OptimizeMD LLC dba DexaFit Cincinnati does not provide professional guidance or recommendations unless the client engages in a formal doctor-patient relationship with Dr. David J. DeMarco, MD, under a separate agreement that includes applicable fees. OptimizeMD LLC dba DexaFit Cincinnati encourages each client to engage in further review or analysis of the report their primary care physician or another health care provider with whom they have established a formal doctor-patient relationship.

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 OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (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 Cincinnati 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 OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (DexaFit, Inc) are not required to agree to these requested restrictions. If agreed, OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (DexaFit, Inc) are 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 OptimizeMD LLC dba DexaFit Cincinnati and their business associate, (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 OptimizeMD LLC dba DexaFit Cincinnati, except for actions already taken to release this information. This Authorization shall remain valid unless revoked, and DexaFit Cincinnati 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 Cincinnati.

OPTIMIZEMD, LLC DBA DEXAFIT CINCINNATI

AGREEMENT AND INFORMED CONSENT FOR DEXA SCAN

OptimizeMD, LLC dba DexaFit Cincinnati (“Practice”) and   _________________________, (“Patient”) hereby enter into this this Agreement and Informed Consent for a DXA Body Composition Scan (“Dexa”) Scan (“Agreement”) on the date indicated below. 

What is a Dexa Body Composition Scan?

DEXA is a dual-energy x-ray absorptiometry scan that is capable of measuring body composition.  It is a fast, non-invasive procedure that uses low doses of x-rays to measure body composition.  Although traditionally used to diagnose osteoporosis (using a segmental Dexa Scan), a Body Composition Scan is different. It will provide detailed insights into Patient’s body fat percentage, muscle mass, bone density and more.  Dexa is a scientifically validated scan that, when operated correctly, has accuracy to within 2-3% of true values for fat mass, lean tissue mass, and bone mineral content. It is considered the gold-standard for body composition testing. Dexa goes beyond surface-level measurements, offering Patient a deeper understanding of his or her overall health.  

Key Benefits of a DXA Scan 

The Dexa Scan will provide Patient with a clear breakdown of fat mass, lean tissue mass, and bone mineral content for a complete picture of Patient’s body composition.  By analyzing body composition, including fat distribution, it can help identify risks for conditions such as heart disease and diabetes. Measuring lean tissue mass enables detailed muscle analysis, providing key insights such as the Appendicular Lean Mass Index (ALMI), a metric closely linked to longevity and survival benefits. While not diagnostic for osteoporosis, the Dexa Body Composition Scan can provide a whole-body bone density estimate, providing the patient additional information to discuss with his or her healthcare provider.

Risks of a Dexa Scan. 

The Dexa Scan involves radiation exposure which is significantly less than a person would receive from a standard chest X-ray or a dental X-ray.  While the radiation exposure from a Dexa Scan is low, it is not recommended for pregnant women because even low doses of radiation can be harmful to an unborn child.  Practice will not perform a Dexa Scan if Patient is pregnant or there is a possibility of pregnancy.  Consequently, some Patients may be required to have a urine pregnancy test for confirmation.  There are no risks associated with a urine test for pregnancy.

Preparing for the Dexa Scan Appointment.  

Prior to Patient’s appointment day for the Dexa Scan, Patient was told that a Dexa Scan will not be performed if Patient is pregnant or there is a possibility that Patient may be pregnant.  Further, Patient was instructed that he or she should FAST for 2 hours prior to the scan, and should avoid exercise or other vigorous activity on the day of the exam.  Patient was instructed to hydrate prior to the exam and not take any calcium or Tums in the 24 hours leading up to the exam.  If Patient had a barium study; was injected with contrast for CT or MRI Scan; or had a Nuclear Medicine study, Patient was instructed to schedule his or her Dexa Scan appointment at least 7 days later.  Patient was also instructed that he or she should wear tights, sports bra, compression shorts or other athletic attire without metal buttons, snaps, zippers or bra clasps.  Patient also instructed to refrain from any clothing or undergarments that contain metallic imprinting inks or threads and to wear socks. Patient was instructed that they will need to empty pockets and remove metal items like watches, belts, glasses, and jewelry.

What to Expect During Your DXA Scan Visit 

The Dexa scan is a straightforward, painless, and non-invasive procedure. Patient will be asked to lie still on his or her back on an open-air DEXA scan table for approximately 10 minutes while the scanner does its work making a soft humming noise.  The technologist administering the Dexa Scan will try to make Patient as comfortable as possible.  Due to the extremely low radiation dose, the technologist will remain in the room.  After the scan, Patient will receive a comprehensive report.

Detailed Report and Personalized Consultation

After the scan, Patient will receive a detailed report with actionable insights into his or her body composition, including fat mass and distribution, muscle mass and distribution, a total body bone mineral composition analysis, and additional calculated insights including visceral adiposity tissue (VAT) mass and Appendicular Lean Mass Index (ALMI calculation).A brief personalized discussion will occur after the test with Practice staff to help understand the report and apply results to your nutrition and fitness goals. A brief personalized discussion will occur after the test with Practice staff to help understand the report and apply results to your nutrition and fitness goals.  If Patient would like for Practice’s physician Dr. DeMarco to provide a personalized consultation to help interpret the data, identify potential health risks, and create a plan to optimize your fitness and wellness, Patient agrees to engage Practice to do so by signing an agreement for further services and pay the required associated fees for those further services. 

Fees for Dexa Scan

Patient agrees to pay the Practice a non-refundable fee when scheduling their DEXA scan appointment. The current price of a DEXA scan is $199, subject to change. Promotional discounts may be available but are not guaranteed. Additional expenses may be incurred for AI-enhanced upgraded reports, currently priced at $99. At the time of Patient’s appointment, he or she shall sign this Agreement and any other required documents such as the Notice of Privacy Practices. The non-refundable fee is for the Dexa Scan, written report (printed and or digital PDF copy) of the result of the Dexa Scan.  It does not include any personalized consultation by Practice’s physician or AI-enhanced upgrades.  

No Insurance or Government-Funded Healthcare Plans.

Patient is responsible for payment to Practice for the Dexa Scan services. Practice shall not bill any third-parties, insurance companies or government-funded healthcare programs, such as Medicare, Tricare, Medicaid or Indian Health Services, etc.  If Patient is a beneficiary of any government-funded healthcare program such as those previously listed, Patient shall inform Practice of this fact and shall sign Practice’s Medicare Private Contract. 

No Physician-Patient Relationship 

The services provided under this Agreement do not: 1) establish a provider-patient relationship beyond the Dexa Scan service provided to Patient herein; 2) obligate Practice and its physician to provide additional or further follow-up care beyond the Dexa Scan service provided herein; or 3) create any obligation to order or refer Patient for further exams, test, or specialty care.  Patient agrees to be responsible for contacting his or her regular healthcare provider to obtain appropriate follow-up care or to address any questions or conditions that may arise.  Patient understands that if he or she wants to continue to be treated by Practice and its physician, Patient shall enter into further agreement(s) for services and pay the associated fees for those services.  

General Terms

This Agreement, once signed by Patient, constitutes the entire understanding between Patient and Practice and will be interpreted according to Ohio law. Patient and Practice specifically acknowledge that, by Practice’s offer and Patient’s acceptance of this Agreement, each is relying solely upon the representations and agreements contained in this Agreement and no others.  All prior representations or agreements, whether written or oral, not expressly incorporated herein, are superseded and of no force or effect, and no changes in or additions to this Agreement will be recognized unless and until made in writing and signed by Patient and Practice.  

Any questions about the procedures used in the Dexa Scan or the results of your test are encouraged. If you have any concerns or questions, feel free to ask via email at cincinnati@dexafit.com prior to the test.

OPTIMIZEMD, LLC DBA DEXAFIT CINCINNATI

AGREEMENT AND INFORMED CONSENT FOR VO2 Max Test

OptimizeMD, LLC dba DexaFit Cincinnati (“Practice”) and   _________________________, (“Patient”) hereby enter into this this Agreement and Informed Consent for a VO2 Max Cardiopulmonary Fitness Test (“VO2 Max”) test (“Agreement”) on the date indicated below. 

What is a VO2 Max Cardiopulmonary Fitness Test?

The VO2 Max test is a scientifically validated assessment designed to measure Patient body’s maximum capacity to utilize oxygen during exercise. It provides insights into Patient cardiovascular fitness by evaluating oxygen intake and carbon dioxide output while performing a graded exercise protocol. This non-invasive test is recognized as the gold standard for assessing aerobic capacity and endurance.

Key Benefits of a VO2 Max Test 

The VO2 Max test offers personalized data that helps optimize Patient fitness, training, and overall health. It identifies Patient unique aerobic capacity, determines heart rate training zones, and evaluates Patient overall endurance. This information is valuable for tailoring exercise programs, improving athletic performance, and supporting long-term cardiovascular health and longevity.

Risks of a VO2 Max Test. 

While the VO2 Max test is generally safe, it involves physical exertion and carries inherent risks, including abnormal blood pressure, fainting, irregular heart rhythms, or, in rare cases, more serious events such as heart attack or stroke. To ensure Patient safety, it is essential to report any unusual symptoms during the test. It is strongly recommended that Patient consult Patient physician before participating, especially if Patient have known medical conditions or concerns. It is always advised to discontinue the test voluntarily if Patient are feeling any concerning symptoms. An AED will be available at the Practice location at all times.

Preparing for the VO2 Max Appointment.  

To achieve accurate results, it is important to prepare for the VO2 Max test. Avoid strenuous exercise, caffeine, supplements or stimulants and large meals for at least 3 hours before Patient appointment. Avoid alcohol for at least 12 hours prior to testing. It is OK to take Patient prescription medication the day of the test. Avoid exercise or any other vigorous activity for at least 12 hours prior to testing. Wear comfortable clothing and shoes suitable for exercise. Please inform the staff of any medical conditions, medications, or recent injuries that could affect Patient performance.

What to Expect During VO2 Max Visit 

During the test, Patient will perform a graded exercise protocol on a treadmill or stationary bike while wearing a mask to measure oxygen and carbon dioxide exchange. The intensity will gradually increase until Patient reaches his or her maximum capacity or chooses to stop. Patient heart rate and breathing will be continuously monitored, and Patient may stop the test at any time if Patient feel discomfort or fatigue. Valuable insights can still be obtained from a sub-maximal VO2 Max test, so it’s important to listen to his or her body and stop if he or she feels the need to shorten the test.

Detailed Report and Personalized Consultation

After the scan, Patient will receive a detailed report that includes his or her aerobic capacity, heart rate training zones, and other key fitness metrics. A brief personalized discussion will occur after the test with Practice staff to help understand the report making it easier for Patient to apply results to Patient health and fitness goals. If Patient would like for Practice’s physician Dr. DeMarco to provide a personalized consultation to help interpret the data, identify potential health risks, and create a plan to optimize Patient fitness and wellness, Patient agrees to engage Practice to do so by signing an agreement for further services and pay the required associated fees for those further services. 

Fees for VO2 Max

Patient agrees to pay the Practice a non-refundable fee when scheduling their VO2 max appointment. The current price of a VO2 Max test is $229, subject to change. Promotional discounts may be available but are not guaranteed. Additional expenses may be incurred for AI-enhanced upgraded reports, currently priced at $99. At the time of Patient’s appointment, he or she shall sign this Agreement and any other required documents such as the Notice of Privacy Practices. The non-refundable fee is for the VO2 max test, written report (printed and/or digital PDF copy) of the result of the VO2 Max test.  It does not include any personalized consultation by Practice’s physician or AI-enhanced upgrades.  

No Insurance or Government-Funded Healthcare Plans.

Patient is responsible for payment to Practice for the VO2 Max services. Practice shall not bill any third-parties, insurance companies or government-funded healthcare programs, such as Medicare, Tricare, Medicaid or Indian Health Services, etc.  If Patient is a beneficiary of any government-funded healthcare program such as those previously listed, Patient shall inform Practice of this fact and shall sign Practice’s Medicare Private Contract. 

No Physician-Patient Relationship 

The services provided under this Agreement do not: 1) establish a provider-patient relationship beyond the VO2 Max service provided to Patient herein; 2) obligate Practice and its physician to provide additional or further follow-up care beyond the VO2 max service provided herein; or 3) create any obligation to order or refer Patient for further exams, test, or specialty care.  Patient agrees to be responsible for contacting his or her regular healthcare provider to obtain appropriate follow-up care or to address any questions or conditions that may arise.  Patient understands that if he or she wants to continue to be treated by Practice and its physician, Patient shall enter into further agreement(s) for services and pay the associated fees for those services.  

General Terms

This Agreement, once signed by Patient, constitutes the entire understanding between Patient and Practice and will be interpreted according to Ohio law. Patient and Practice specifically acknowledge that, by Practice’s offer and Patient’s acceptance of this Agreement, each is relying solely upon the representations and agreements contained in this Agreement and no others.  All prior representations or agreements, whether written or oral, not expressly incorporated herein, are superseded and of no force or effect, and no changes in or additions to this Agreement will be recognized unless and until made in writing and signed by Patient and Practice.  

Any questions about the procedures used in the VO2 Max test or the results of your test are encouraged. If you have any concerns or questions, feel free to ask via email at cincinnati@dexafit.com prior to the test.


OPTIMIZEMD, LLC DBA DEXAFIT CINCINNATI

AGREEMENT AND INFORMED CONSENT FOR RMR TEST

OptimizeMD, LLC dba DexaFit Cincinnati (“Practice”) and   _________________________, (“Patient”) hereby enter into this this Agreement and Informed Consent for a Resting Metabolic Rate Test (“RMR”) test (“Agreement”) on the date indicated below. 

What is a Resting Metabolic Rate (RMR) Test?

The Resting Metabolic Rate (RMR) test is a non-invasive assessment that measures the number of calories Patientr body burns at rest to sustain essential functions such as breathing, circulation, and digestion. This test involves analyzing Patientr oxygen consumption and carbon dioxide production while Patient relax in a seated or reclined position. The results provide insights into Patientr unique metabolic rate, forming the foundation for personalized nutrition and weight management plans.

Key Benefits of an RMR Test 

The RMR test provides critical data for creating effective and sustainable health strategies. It determines Patientr daily caloric needs at rest, allowing for precise nutrition planning and tailored weight-loss, weight-maintenance, or performance diets. Understanding Patientr RMR can help Patient avoid under-eating or over-eating, improve energy balance, and achieve long-term health goals.

Risks of an RMR Test. 

The RMR test is considered a safe and non-invasive procedure with minimal risks. Potential minor discomfort may arise from wearing a mask or mouthpiece during the test. Individuals with certain respiratory conditions may experience mild challenges, and it is recommended to consult with Patientr physician before participating if Patient have any health concerns.

Preparing for the RMR Appointment.  

To ensure accurate results, avoid eating or drinking anything other than water for at least 4 hours prior to Patientr appointment, and preferably 8 hours. Patient should refrain from exercising for at least 12 hours beforehand, and avoid caffeine, nicotine, and alcohol during this period. Patient should wear comfortable clothing and casual and even business attire is acceptable for this test as Patient will be relaxing in a chair. Patient is to  inform the staff of any medical conditions or recent changes in health.

What to Expect During RMR Visit 

During the RMR test, Patient will sit or recline in a comfortable position while wearing a mask or mouthpiece connected to the metabolic analyzer. Patient will breathe normally for approximately 10-20 minutes as the system measures Patientr oxygen consumption and carbon dioxide output. The process is quiet and relaxing, requiring no physical effort on Patientr part.

Detailed Report and Personalized Consultation

After the test, Patient will receive a detailed report outlining Patientr resting metabolic rate and caloric requirements. This report may include additional metrics, such as Patientr respiratory quotient (RQ), to assess how Patientr body utilizes fat and carbohydrates for energy. A brief personalized discussion will occur after the test with Practice staff to help understand the report and apply results to Patientr nutrition and fitness goals. If Patient would like for Practice’s physician Dr. DeMarco to provide a personalized consultation to help interpret the data, identify potential health risks, and create a plan to optimize Patientr fitness and wellness, Patient agrees to engage Practice to do so by signing an agreement for further services and pay the required associated fees for those further services. 

Fees for RMR

Patient agrees to pay the Practice a non-refundable fee when scheduling their RMR appointment. The current price of an RMR test is $229, subject to change. Promotional discounts may be available but are not guaranteed. Additional expenses may be incurred for AI-enhanced upgraded reports, currently priced at $99. At the time of Patient’s appointment, he or she shall sign this Agreement and any other required documents such as the Notice of Privacy Practices. The non-refundable fee is for the RMR test, written report (printed and/or digital PDF copy) of the result of the RMR test.  It does not include any personalized consultation by Practice’s physician or AI-enhanced upgrades.  

No Insurance or Government-Funded Healthcare Plans.

Patient is responsible for payment to Practice for the RMR services. Practice shall not bill any third-parties, insurance companies or government-funded healthcare programs, such as Medicare, Tricare, Medicaid or Indian Health Services, etc.  If Patient is a beneficiary of any government-funded healthcare program such as those previously listed, Patient shall inform Practice of this fact and shall sign Practice’s Medicare Private Contract. 

No Physician-Patient Relationship 

The services provided under this Agreement do not: 1) establish a provider-patient relationship beyond the RMR service provided to Patient herein; 2) obligate Practice and its physician to provide additional or further follow-up care beyond the RMR service provided herein; or 3) create any obligation to order or refer Patient for further exams, test, or specialty care.  Patient agrees to be responsible for contacting his or her regular healthcare provider to obtain appropriate follow-up care or to address any questions or conditions that may arise.  Patient understands that if he or she wants to continue to be treated by Practice and its physician, Patient shall enter into further agreement(s) for services and pay the associated fees for those services.  


General Terms

This Agreement, once signed by Patient, constitutes the entire understanding between Patient and Practice and will be interpreted according to Ohio law. Patient and Practice specifically acknowledge that, by Practice’s offer and Patient’s acceptance of this Agreement, each is relying solely upon the representations and agreements contained in this Agreement and no others.  All prior representations or agreements, whether written or oral, not expressly incorporated herein, are superseded and of no force or effect, and no changes in or additions to this Agreement will be recognized unless and until made in writing and signed by Patient and Practice.  

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