By participating in the draw of a small finger prick blood sample performed by Keto5, to test your ketone readings, the undersigned individual agrees and acknowledges the following:

The primary purpose of this blood screening is to demonstrate how to take and assess readings using the Keto-Mojo Glucose and Ketone Meter.  Keto5 staff will also provide information and resources regarding the ketogenic lifestyle. By choosing to participate in this blood ketone level screening, you certify that you are in good health and above the age of 18. You also understand that the health screening results are intended to be used for educational purposes only and are not designed to replace the care or advice of a medical provider.

You acknowledge that you have read this document in its entirety (or that it has been read to you), and that you understand and agree to the above. Your permission to perform this blood screening is given voluntarily and extends to all screening personnel, including volunteers. You also fully understand the associated risks or discomforts and have had an opportunity to ask questions that have been answered to your satisfaction.

You hereby hold harmless and release Keto5 and all their personnel, representatives, and agents from any and all injuries and damages occurring in the course of your participation in this blood screening, other than those caused by the gross negligence or intentional misconduct of the party to be charged

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