Intake Form

Please fill out this intake form to the best of your ability. Accurate and complete answers will help us provide you with the best possible testing experience and results.
Qualifying Questions
Please let us know why you are getting a DEXA scan. You must answer yes to one of the following questions to qualify for the scan.
  1. Do you currently or have you ever had concerns about your weight?
  2. Would you like to reduce your current body fat percentage?
  3. Are you interested in understanding your body composition or bone mineral density?
  4. Do you or any of your immediate family members have heart disease or diabetes?
  5. Do you have high blood pressure?
  6. Are you currently suffering from any joint, muscular or ligamentous injuries?
Additional Information
If you answer yes to any of the following, you will not be able to scan. Contact us at hello@dexachs.com and we will happy to help you reschedule or to issue you a refund.
  1. Have you had a barium X-ray in the last 2 weeks?
  2. Have you had a nuclear medicine scan or injection of an X-ray dye in the last week?
  3. Are you pregnant or is there a chance you are pregnant?
Thank you! We look forward to seeing you!
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