We want to acknowledge your courage and willingness in reaching out for help. By answering the questions in this form as fully as you can you’ve taken an important step towards getting that help! When you get to the bottom of each page, click NEXT until you reach the end. You will be asked to sign before you can submit. Thank you! ** Allow about 5-10 minutes ** Make sure to finish in one sitting, and SUBMIT at the end, or your info may be lost. Please fill in all of the information below with as much detail as you can and to the best of your ability so that you may recieve the best care possible!*Note: I have no way of manipulating the scan based on your info as it communcates with your body using bio-frequencies and electriomagnetic signals from your OWN voice. More than 120,000 vibrational frequencies have been isolated, identified & catalogued by AO Scan. The technology reads, interprets energy, vibration and resonance signals. Every cell is made of energy and the signals measure and guide the body back to homeostasis. "When your mind, body, & spirit are homeostasis, you will find your golden OASIS!" -Krista Bigler You will be asked to sign before you can submit. Thank you! Please hydrate as well as possible before your scan and keep us updated on how you are feeing afterward.*This information will be kept strictly confidential. Our personal information is collected for the purpose of providing care and for administrative purposes. It will not be disclosed for other purposes without your consent.