Bio Scan Assessment / Waiver

I do hereby voluntarily consent to and request to have a Bio Scan screening performed on me by ITHRIVE Health LLC. This may include, but is not limited to, having my blood pressure taken, Bio scans, and participating in a variety of additional screenings. I am aware that these procedures are only screens and that I should consult my personal physician for evaluation of all results. I understand that the responsibility for initiating follow-up with my personal physician lies with me.In accepting these screening tests and assessments, I hereby waive all claims against the ITHRIVE Health LLC, its respective employees, entities, agents and/or other volunteer health professionals with regard to acts performed and services rendered, statements made or results reported to me in connection with the health screening tests and assessments. I further release the ITHRIVE Health LLC, its respective employees, entities, agents and/or other volunteer health professionals, from any and all liability, includingany matter or thing concerning any follow-up I certify that I have read and fully understand assurance has been made to me concerning assessments.

 

Assignment of Benefits

For the medical expense allowable under my health or PIP, and otherwise payable to me under my current insurance policy as payment toward the total charges for all services rendered. This is a direct assignment of my rights and benefits under this policy to ITHRIVE Health. This payment will not exceed my indebtedness to the above-mentioned assignee."I also authorize the release of any information pertinent to my case to you as the insurance company and /or attorney."