CLIENT DISCLAIMER AND LIABILITY WAIVER


I intend to obtain nutritional information, recommendations and services, and clinical laboratory services (also known as “blood work”) from Body by AIM360 Virtual, LLC and its professional health care providers.

 

I understand that federal law and Food and Drug Administration (“FDA”) regulations mandate only approved drugs and medication can be used for treating, diagnosing, curing and preventing medical disease.  Certain types of diets, nutritional type supplements and foods are generally not approved by the FDA to treat, diagnose, cure or prevent any disease. 

 

Accordingly, I understand that Body by AIM360 Virtual, LLC, its owners, employees, professional health care providers, associates or agents will not, and do not intend to treat, diagnose, prevent or cure any medical condition that I may have.  Body by AIM360 Virtual, LLC and its professional health care providers provide general nutritional information, nutritional recommendations and clinical laboratory blood work that are used for educational purposes only.  These nutritional and clinical laboratory services do not identify the presence of any disease or pathology and they are not a method of treatment, cure or prevention.  These nutritional and clinical laboratory services cannot be billed to or reimbursed by an insurance company.  I understand and agree that nutritional and clinical laboratory information, recommendations and services, and any conversations I have with any professional health care provider, employee or agent of Body by AIM360 Virtual, LLC are not intended to diagnose, cure, prevent or treat any medical condition that I may have. 

 

In addition, I understand and agree that the nutritional supplements and/or clinical laboratory blood work that I may decide to purchase from, or which is arranged by, Body by AIM360 Virtual, LLC or from other sources recommended by Body by AIM360 Virtual, LLC are not intended to treat, diagnose, prevent, or cure any medical disease.   

 

With respect to clinical laboratory blood work recommended by Body by AIM360 Virtual, LLC, I understand and agree that Body by AIM360 Virtual, LLC and its professional health care providers will review the clinical laboratory results, upload the results on a computerized electronic application, and provide information and education with respect to the clinical laboratory results.  I understand and agree that Body by AIM360 Virtual, LLC and its professional health care providers will not provide any medical advice with respect to the clinical laboratory results.  If any clinical issues arise, Body by AIM360 Virtual, LLC and its professional health care providers may provide information directing me to seek medical treatment from my primary care physician; however, neither Body by AIM360 Virtual, LLC nor its professional health care providers undertake any legal or clinical responsibility to diagnose, treat or make medical recommendations or prescriptions, and it is my sole and exclusive legal responsibility to seek independent treatment from my primary care physician located in my state.  I accept full responsibility to periodically monitor any electronic transmissions sent by Body by AIM360 Virtual, LLC or its professional health care providers to me and take all necessary measures to seek medical care from my primary care physician when indicated.

 

I understand and agree Body by AIM360 Virtual, LLC, its professional health care providers and its employees or agents will not recommend that I stop taking any medication or make recommendations about any medication that I am taking.  Only medical doctors can treat medical disease.  If I have a medical disease that I am concerned about, I understand and agree that I should seek immediate treatment from my medical doctor.  I understand Body by AIM360 Virtual, LLC does not employ Chiropractors, Medical Doctors, Nurse Practitioners, Doctors of Osteopathic Medicine or Naturopathic Doctors that are licensed in my state.  Furthermore, I understand that Body by AIM360 Virtual, LLC is not recommending that I stop any medical care and that I should consult my medical doctor about nutritional supplements and ensure that I have a primary care doctor to evaluate my health and the presence of disease.  Body by AIM360 Virtual, LLC is only giving me nutritional and clinical laboratory information and recommendations for solely educational purposes.  Body by AIM360 Virtual, LLC is not intending to replace my medical doctor or a licensed health care provider in my state. 

 

Because these services are being requested to address general nutritional information, I (the “client” not “patient” of Body by AIM360 Virtual, LLC) acknowledge that these services DO NOT constitute medical treatment or health care. 

 

I acknowledge that no doctor-patient or provider-patient relationship has been established between Body by AIM360 Virtual, LLC or any of its owners, professional health care providers, employees, associates, or agents on one hand, and myself on the other hand.  I expressly and unequivocally waive my legal rights to assert the existence of any legal duty of care against Body by AIM360 Virtual, LLC, its owners, professional health care providers, employees, associates, or agents.

 

In consideration of my ability to access the nutritional and clinical laboratory information, supplements and supplies provided by Body by AIM360 Virtual, LLC promptly and in the context of enhancing my nutritional status, I release and forever discharge Body by Aim Virtual, LLC, its owners (including Alexandra Dubyak, RN, BSN, MSN-FNP and Darren Dubyak, D.C., ABAAHP, CFMP), members, officers, agents, employees, servants, successors and assigns and agree to hold each harmless and forever release and discharge them from any claims, damages, losses, causes of action, disputes, demands, liability, costs, expenses (including without limitation expert witness fees and other court costs) and attorneys’ fees, of any nature whatsoever whether known or unknown, suspected or unsuspected, past, present or future, whether in contract or tort, whether for negligence, professional malpractice, ostensible or apparent agency, negligent referral, lack of informed consent, misrepresentation, fraud, breach of confidentiality, breach of privacy or any other action or cause of action at law or in equity, on account of injuries known or unknown, present or future, sustained or allegedly sustained by me or in any way arising out of any nutritional and clinical laboratory information, recommendations and services I obtained from and which were rendered by Body by AIM360 Virtual, LLC, its owners, employees, professional health care providers or agents. I further agree not to initiate any complaints against Alexandra Dubyak, RN, BSN, MSN-FNP and Darren Dubyak, D.C., ABAAHP, CFMP (or any other licensed provider affiliated with Body by AIM360 Virtual, LLC) with any licensure board relating to the nutritional and clinical laboratory information, recommendations and services provided.

 

Body by AIM360 Virtual, LLC is located at 5700 Corporate Drive, Suite 410, Pittsburgh, PA  15237.  Darren Dubyak, D.C. is a Doctor of Chiropractic licensed to practice in the Commonwealth of Pennsylvania.  Alexandra Dubyak, RN, BSN, MSN-FNP is a Certified Registered Nurse Practitioner licensed to practice in the Commonwealth of Pennsylvania.  Body by AIM360 Virtual, LLC currently does not employ any health care providers that are licensed in my state.

 

I agree that before beginning any nutritional or wellness plan, I will notify my primary care physician or other licensed providers of health care of my intention to use nutritional and wellness services, the nature of the nutritional and wellness services to be provided and any wellness plan that may be utilized.  I also agree to ask my primary care physician or other licensed providers of health care about any potential drug interactions, side effects, risks or conflicts between any medication or treatments prescribed by my primary care physician or other licensed providers of health care and the nutritional services I may receive.

 

I understand and agree that any nutritional and clinical laboratory information, recommendations or services provided by Body by AIM360 Virtual, LLC, its employees, professional health care providers and agents constitutes general educational information relating to nutrition, general clinical laboratory analysis, wellness and diet.  Any nutritional or clinical laboratory information, recommendations and services provided by Body by AIM360 Virtual, LLC, its employees, professional health care providers and agents does not involve and shall not be construed as medical or a chiropractic diagnosis or treatment.  I agree I will obtain all medical, chiropractic and health care services from a licensed health care professional in my state.

 

I represent and warrant that no promise, inducement, or agreement not expressed herein has been made to me, that this is the complete agreement between Body by AIM360 Virtual, LLC, Alexandra Dubyak, RN, BSN, MSN-FNP and Darren Dubyak, D.C., ABAAHP, CFMP and myself, and that there are no written or oral understandings or agreements, directly or indirectly connected with this release which are not incorporated herein.  I agree that this release and indemnification applies to myself and my heirs, executors, administrators, successors and assigns.  I intend to be legally bound hereby.  

 

I have fully read, understand and agree to all of the above.

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Signature Certificate
Document name: CLIENT DISCLAIMER AND LIABILITY WAIVER
lock iconUnique Document ID: 5abbfcbc2df1795bcb01ca1f39cdd0427f5f8ccb
Timestamp Audit
September 28, 2022 2:13 am GMTCLIENT DISCLAIMER AND LIABILITY WAIVER Uploaded by Nauman Ahmed - [email protected] IP 2001:8f8:1473:1975:b1d1:3f74:717b:6fe7