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I hereby give my informed consent and acknowledge that I have read and understood the following terms and conditions related to the screening for lifestyle diseases:


I agree to undergo screening for lifestyle diseases using the OxIA DM Product. The screening has been explained to me in detail, including its purpose, potential benefits, and possible risks.


I understand that the OxIA DM Product is a cloud-based platform designed to help detect, diagnose, and treat lifestyle diseases ().



I understand that this consent is voluntary, and I have the right to ask questions and seek additional information regarding the screening and OxIA Product. I acknowledge that I have been provided ample time to consider the information provided to me. I furthermore acknowledge that OxIA does not give any warranty or guarantee regarding the results and/or outcome and/or suitability of the screening done using the Product.



    1.       I am aware that my personal and medical information will be treated with confidentiality and in accordance with applicable data protection laws. I furthermore acknowledge that I have read and understood OxIA's Privacy Policy insofar as it applies to me in my capacity as a patient.

    2.       I hereby consent to OxIA, my healthcare provider and third-party service providers lawfully collecting, processing, storing and transferring my personal and medical information, as identified in the relevant data protection laws and the OxIA Privacy Policy, in accordance therewith and to process such information insofar as it relates to the use of the Product.


  1.       OxIA may process my medical and/or personal information:


  1.       to analyze and/or improve the use of the OxIA DM Product;


  1.       to facilitate my medical treatment; and


  1.       for research and analytical purposes.



  1.       I understand that the effect of this consent form and agreement is that I may have limited or no recourse against OxIA in the circumstances referred to herein.


  1.       I am aware that undergoing screening using the Product is entirely at my own risk and that neither OxIA nor any of its shareholders, directors, officers, employees, trustees, agents or affiliates ("collectively "Indemnified Party") shall be liable in any manner for any damage, injury, claims or losses which I may sustain in consequence of the screening and/or further treatment in relation thereto.


  1.       I indemnify the Indemnified Party against all claims, losses, demands, actions, injury, death, damages and causes of action whatsoever arising directly or indirectly from my screening, further treatments and/or other use of the Product, whether suffered by me. The Indemnified Party will not be liable for any claim, loss, damage, injury or death that may result, directly or indirectly, from your use of the OxIA DM Product.


  1.       I accept that some of the information, content, tools or materials used in respect of the OxIA DM Product come from external sources (including independent practitioners in the health and wellness industry, and companies that provide OxIA with the use of their artificial intelligence and related technology), and I agree that the Indemnified Party is not responsible, and will not be held liable, for any information or content, received from these external sources or for any loss or damages, including direct, indirect and consequential loss, that may arise from the use of this information or content.




I understand that I am responsible for the costs associated with the screening and any follow up treatment. I furthermore acknowledge that I have been informed of the estimated costs and any payment terms or options available to me. I agree to fulfil my financial obligations promptly and in accordance with the agreed-upon terms.



I grant permission to my healthcare practitioner and/or screening center and/or OxIA and/or authorized third parties to communicate with me regarding my screening, results and any further treatment required, including appointment reminders, test results and general health-related information via phone, email, SMS, or other appropriate channels.



    1.       I acknowledge that I have read and understood the above information, and I voluntarily and knowingly consent to, and accept the terms and conditions set out herein including the screening and any further treatment required.

    2.       Where a parent or guardian is consenting to and accepting this Patient Consent Form on behalf of a minor patient, the parent or guardian understands and declares that he/she is legally authorized to act on behalf of the minor patient.

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