fbpx Skip to content
menu
Book A SCREENING

Book a screening

"*" indicates required fields

Step 1 of 3

33%
If you answer YES to any of the following questions, please contact our offices before completing this form:  1 844 MY BODYK (692-6395)
  • Are you pregnant?
  • Do you have an implantable pacemaker or cardiac device?
  • Do you have any metal in your body or prosthetic joint or limb?
  • Do you have a cardiac arrhythmia or atrial fibrillation?

INFORMED CONSENT TO PERFORM BIOMARKERS SCREENING

This Informed consent gives BodyK permission to conduct the BodyKnows Biomarker Assessment or/and the BodyK Fit Screening. Please read this Consent carefully.

I understand that:

  • I am entitled to receive a copy of this Informed Consent, my screening results, and any other protected health information that is collected by BodyK in connection with my preventive screenings.
  • A diagnosis can only be made by a qualified physician or licensed healthcare professional.
  • The results collected here by BodyK will be held securely and confidentially by BodyK
  • The screening results will not be used by BodyK for purposes of individual health information or to make a diagnosis of any disease or illness.
  • BodyK is a preventive health screening and education company that provides information and supports its community wellness initiative. BodyK does not practice medicine and is not a substitute for my doctor’s care.
  • I am responsible for contacting my primary care doctor for questions about any specific medical needs that may be indicated by these biometric screenings. I will not hold BodyK responsible for providing information, diagnosis or treatment as a substitute for the care I receive from my physician or other qualified healthcare provider.
  • If I have a concern about my screening result, I am responsible for following up with my primary care physician.
  • I recognize that if I do not sign this Informed Consent, BodyK cannot proceed with the preventive screening. I have had full opportunity to read and consider the contents of this form.

HIPAA ACKNOWLEDGEMENT

By signing this I am acknowledging that I have read and understand BodyK’s Notice of Privacy Practices. I have had full opportunity to read and consider the contents of Privacy Practices. I understand that, by signing this acknowledgement and consent form, I am giving my consent for this office’s use and disclosure of my protected health information to carry out treatment, payment activities and health care options.

A copy of our Notice of Privacy Practices is available online on our website. We encourage you to read it carefully and completely before signing this Consent. We reserve the right to change our privacy practices as described in our Notice of Privacy Practices. If we change our privacy practices, we will issue a revised Notice of Privacy Practices which will contain the changes. These changes may apply to any of your protected health information that we maintain. You may obtain another copy of our Notice of Privacy Practices, including revisions, at any time by contacting our Privacy Officer at BodyKnows@bodyk.net. This consent expires after one year.

I consent to have BodyK perform*
Do you have an account with BodyK?*

Login

Reset password

Register

Full name*
Password*
Strength indicator
Hidden
Name to crm
Hidden

Personal information

MM slash DD slash YYYY
Address*
I have read, understand and agree to BodyK’s screening consent and the BodyK private practices policy*
MM slash DD slash YYYY
Reset signature Signature locked. Reset to sign again

JOIN OUR BLOG

Sign up today! It only takes a second to be the first to find out about our latest news and promotions…

Know yourself for better health

Personal health is a predominant factor in determining quality of life. BodyK believes the power of preventative technology can support a vibrant and healthier you. We provide easy access to clinically proven cutting-edge tools that analyze your current health using our BodyKnows Method.

TECHNOLOGY SUPPORTIVE STUDIES

Services

  • Preventive Biometric Screening
  • Family & B2B Concierge Services
  • SPARK – Special Needs Division
  • Events
  • Preventive Biometric Screening
  • Family & B2B Concierge Services
  • SPARK – Special Needs Division
  • Events

Resources

  • Wellness Blog
  • News Page
  • Research Library
  • Testimonials
  • Wellness Blog
  • News Page
  • Research Library
  • Testimonials

Company

  • About Us
  • Contact
  • Join Our Team
  • Become an Affiliate
  • About Us
  • Contact
  • Join Our Team
  • Become an Affiliate

BodyK © 2022. Read our Terms of service and Privacy Policy

Follow us:
Linkedin-in Facebook-f Icon-instagram-1
  • Home
  • How BodyK Screening Works
  • Where Can I Get Screened?
  • Book A Screening
  • What Can A 7-Minute BodyK Screen Do?
  • Health & Fitness Issues BodyK Identifies
  • Family & B2B Concierge Services
  • About BodyK
  • Contact
  • Other Services
    • Wellness Blog
    • Join Our Team
    • Become an Affiliate or Professional Network
    • Events
  • How BodyK Screening Works
  • Where Can I Get Screened?
  • Book a Screening
  • What Can A 7-Minute BodyK Screen Do?
  • Health & Fitness Issues BodyK Identifies
  • Family & B2B Concierge Services
  • About BodyK
  • Contact
  • Other Services
    • Wellness Blog
    • Join Our Team
    • Become an Affiliate or Professional Network
    • Events
Linkedin Facebook Instagram

JOIN OUR BLOG

Help us prevent spam

Services

CUTTING EDGE - PERSONALIZE - 2

Preventive Screening

Strong business team. Low angle view of four confident business people standing close to each other and holding hands together

B2B

spark

Spark