Liability Waiver

I understand I am entering into a consulting arrangement with Votary, M.D. and its physicians. I am voluntarily participating in this arrangement, and understand and agree to the following:

1. I am at least 18 years old.
2. Votary M.D. and its physicians provide the following:

• At-home Blood testing for PFAS chemicals (which is an environmental and not a medical test).
• Individualized PFAS and other toxin exposure assessments.
• Individualized recommendations as to how to reduce your PFAS exposure and thus your blood levels.
• Review of the NASEM’s guidelines for medical risk and recommended screening based on your PFAS blood test result.
• Phone consultation with your treating physician, if requested by you and your physician.
• Information about how to reduce all toxin exposures.

3. Votary M.D. and its physicians do not practice medicine and therefore do not provide the following:

• Diagnosis of medical conditions.
• Treatment of medical conditions.
• Recommendations about any current medical conditions.

4. This PFAS blood test is not intended for use in the diagnosis of any disease or other conditions, or for use in the cure, mitigation, or treatment of any disease or condition. Only a practicing or treating physician can diagnose a health condition or outcome.
5. I must see my primary care physician or other treating physician to obtain any medical diagnosis, further testing, or medical treatment that might be indicated by the results of PFAS blood testing.
6. I understand and assume the risks of PFAS blood testing, which are outlined in the FAQ section of the website and also in the EmpowerDX consent agreement. These risks include risk of injury or infection at the finger prick site, psychological stress, or concern about the health effects from PFAS exposure, clinical consequences from medical follow-up as a result of elevated PFAS blood levels, and property devaluation should PFAS blood testing lead to testing of an in-home well or soil that shows PFAS contamination.
7. In the event of elevated PFAS blood levels, I will seek immediate medical care from my primary care physician to discuss, and implement as applicable, the NASEM screening and evaluation recommendations provided by Votary, M.D. Votary M.D. is not responsible for arranging any medical screening or follow up that is indicated by the NASEM recommendations.
8. Votary M.D. and its physicians are not liable for any negative consequences of PFAS blood testing, including the risks outlined above, or for any medical consequences that arise from a failure to seek physician care or otherwise implement any recommended medical evaluations and screening.
9. I understand that the likelihood that I will have any specific adverse health outcome because of my PFAS exposure cannot currently be determined with any specificity. PFAS blood test results alone cannot tell if PFAS exposure has caused a specific health condition, or if, or how, PFAS exposure will affect an individual’s health in the future.
10. All PFAS blood test results will be in a HIPPA-secured portal on the EmpowerDX website that the Votary physicians, as outlined in the EmpowerDX client agreement.
11. As overview of individual PFAS blood test results, exposure assessment and recommendations, and clinical guideline recommendations will be discussed via zoom and emailed to the client via a HIPPA secured email.