Brain Boost
Foot Detox
Rife (60 minutes)
Tension Relief
Thank you for signing up for a Body In Balance wellness appointment!
This short form is required for all initial appointments (Foot Detox, Rife, Brain Boost with AO Hub™, and Tension Relief). All Body In Balance appointments are IN PERSON, in the Prineville office and are held in the clinic "Community Space" and therefore are not technically private. To optimize this space to be as private as possible, these appointments must fall within certain times of the day, which is why they must be booked directly with Dr. Terri (or other designated "staff" members).
All required fields (*) must be filled out or it will not submit. Form best filled out on a computer.
Don't forget to click the SUBMIT button at the bottom.
Many of these options are modality specific and may not apply to your specific appointment type. interest and needs often change. Please answer the following questions with "Yes" or "No" (if you are not sure, answer yes and we can tease out the appropriate answer when you arrive for your appointment).
BODY IN BALANCE CONSENT
By checking the boxes below you acknowledge that you have read everything and have answered all questions in full honesty.
Solex AO Technology Consent Agreement and Liability Waiver.
1. Unless legally licensed as a medical practitioner, I fully understand that the Solex Independent Quantum Living Advocate who is assisting me with this analysis using AO Scan Mobile, is simply facilitating the technology.
2. Unless legally licensed as a medical practitioner, I fully understand that the Solex Independent Quantum Living Advocate who is assisting me is prohibited from diagnosing or treating any disease, condition, or illness by prescribing medication, offering medical advice, conducting surgery, or providing any other medical services.
3. I fully understand that the AO Scan Mobile analysis is strictly educational in nature and does not diagnose, treat, cure, or prevent any disease.
4. I fully understand and acknowledge that the AO Scan Mobile uses subtle energy, frequencies, vibration, and resonance to interact with the body’s energy field and measure my body’s response. When it encounters imbalance, it reports those imbalances to me and helps optimize my wellbeing by identifying frequencies that may restore balance.
5. I fully understand that the analysis provided by the AO Scan Mobile is leading-edge technology and is not yet generally accepted by conventional health care professionals. An AO Scan Mobil analysis is not covered by medical insurance.
6. I fully understand that any payment for an analysis is expected at time of service, unless otherwise arranged prior to my session.
7. I acknowledge that no national regulatory body has evaluated any statements made regarding the AO Scan Technology. AO Scan Technology is not intended to diagnose, treat, cure, or prevent any disease.
8. I affirm that I am acting of my own free will and according to the dictates of my own conscience to experience an AO Scan Mobile Analysis.
9. I affirm that I do not represent, nor am I an agent for any state or federal regulatory agency.
10. I affirm that I am requesting this analysis for myself and not for legal recourse.
11. With the acceptance of this consent agreement and liability waiver, I hereby waive and release myself and my heirs, executors, and administrators, from any and all claims of any nature whatsoever and do hereby acknowledge that I will use the services provided at my own risk. I confirm that I have given accurate legal direction and that I am of legal age in this jurisdiction.
Preferred method for Dr. Terri (or staff members) to reach you to set up your appointment:
APPOINTMENT DESCRIPTIONS
Experience the power of transformation with AO Hub™ – the cutting-edge Mind Engagement System designed to elevate your physical, emotional, and mental wellbeing to optimal levels. Dive into a world where advanced brainwave technology tunes your mind for a balanced body and healthy cognitive performance. AO Hub™ zeroes in on key brainwave states, providing a powerful tool for mental rejuvenation. Embark on a healing journey backed by years of groundbreaking scientific research, for complete cognitive and emotional wellness. BENEFITS INCLUDE:
Energize and rejuvenate
Improve mood and meditation
Boost cognitive functions
Achieve deep restorative sleep
Support healthy habits and learning
Energize
Mood
Brain Boost – increase neurotransmitter
production
Deep restorative sleep
Feel healthier
Healthy habits and behaviors
Inner ear, equilibrium support
Learning abilities
Accepting and transitioning mindset(s)
Add-Ons include ear seeds, SEFI dots
Seeking a refresh? Kickstart your detox journey with AO Infinity Foot Detox, the bio-frequency solution to cleanse your system, clear blockages, and tame inflammation. Plus, indulge in the healing embrace of Red Light Therapy for an extra boost in reducing inflammation. Your appointment will include a 30 minute frequency based foot detox, in conjunction with red light therapy (up to 2 locations). Afterwards, you will receive a short terahertz session to palms and feet.
HOW IT WORKS: Blood circulation slows when the body is cold, and the cell metabolism weakens. Every time the body temperature drops one degree, the metabolism is reduced by about 12%, and immunity is reduced by more than 30%. When an individual’s temperature is at 95.9° Fahrenheit, cells multiply. Other viruses and bacteria may invade, and various functional disorders may occur. On the other hand, when an individual’s temperature is at 103.2° Fahrenheit, cells begin to die, and many viruses and bacteria cannot survive. When you place your bare feet on the plates of the device, it will generate a frequency of one megahertz. The device pulses the frequency into the body in 10 millisecond bursts. This delivery mechanism causes the body to go into a low-grade fever, raising the body temperature by one and a half degrees.
Add-Ons include ear seeds, SEFI dots, supportive detox and binder supplements
The F-Scan is a bio-resonance device that is used to identify foreign organisms and substances in the body. The F-Scan is designed to detect the frequency at which infections, viruses, and other causes of illness resonate. It detects Pathogens like Parasites, Fungi, Viruses, Bacteria, Protozoa, and Worms. The procedure is quick and non-invasive, and a printout of the scan is given to the client.
Please note: Rife appointments are booked with Rebecca Davis, PT ANA
Unlock serenity and balance with our rejuvenating sessions, harnessing the power of Red Light Therapy, TeraHertz Bio Frequency, and Rapid Release treatments. Witness tension dissolve and embrace enhanced mobility, heightened well-being, and an enriched life! This session begins with 20 minutes of Red Light Therapy in up to 3 areas, followed by targeted soft tissue hands-on care using vibration to bust through tight fascia and relieving muscle tension, ending with the soothing application of TeraHertz Bio Frequency!
Add-Ons include ear seeds, SEFI dots