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Please review, complete, and submit the consent form below prior to the scheduled appointment. You may also print the form and bring to the appointment.

Child's information:

    Parent or Legal Guardian's information:

    Release and Waiver of Liability

    Athletic Height Projections (AHP) is not a medical facility and does not provide medical care. AHP offers elective x-rays for the purpose of projecting the height of a child upon reaching full maturity by conducting an x-ray of the child’s left hand. This non-diagnostic x-ray is to be used for purposes of conjecture, based on an evidence-based calculation only, and will not provide any diagnosis or medical information of any kind. It is not intended to take the place of a medically necessary diagnostic x-ray or any other medical procedure(s) recommended by a child’s physician or other health care provider. As a condition of receiving the x-ray from AHP, I, hereby acknowledge, understand and agree to the following:
    • I am the parent or legal guardian of the child for whom I am requesting this x-ray.
    • The x-ray is intended solely for the purpose of projecting the future height of my child.
    • This x-ray is an elective, non-medical procedure that I have voluntarily requested on behalf of my child. I understand this x-ray is not intended to take the place of a diagnostic x-ray or any other tests or treatments that have been or may be recommended by a healthcare provider.
    • The technician performing the x-ray is not a physician and cannot interpret diagnostic images or otherwise offer medical conclusions regarding the images. I understand that the x-ray will not be reviewed by a radiologist or other physician.
    • I understand that I am responsible for contacting my child’s health care provider if I have any concerns about my child’s growth, development or medical needs.
    • I understand that factors beyond AHP’s control may affect the ability to accurately project the future height of my child and that there is no warranty or guarantee as to the accuracy of such projection.
    • I understand that I am financially responsible for payment in full for all services provided. I understand that AHP does not bill or accept any medical insurance plans.
    • I release and hold harmless AHP and its managers, members, agents and employees (all referred to as the “released parties”) from any and all claims or causes of action for injury, harm, loss, damage, or other liability, whether caused by the negligence of the released parties or otherwise, that result from or are alleged to have resulted from, AHP’s services or the x-ray. In addition, I agree to release and hold harmless the released parties from any and all claims or causes of action for injury, harm, loss, damage, or other liability which result from, or are alleged to result from, the failure of the released parties to accurately predict my child’s height at full maturity.
    To download and save a copy, please go to: https://tinyurl.com/AHP-waiver-release [11738152v2]