Intake Forms

Intake Forms

Intake Forms

Intake Forms

Thank you for your interest in the BioScan SRT/MSA!

For new clients, please either print or electronically sign the following intake forms.
Email or mail us the signed forms at least 48 hours (2 days) before your appointment. Thank you.

Client Bill of Rights (MN clients only) →
Intake Form →
Release Form →
Terms and Services (Client Agreement) →

The Day of Your in-Person Appointment:
Our testing is performed on a strict schedule, so please be on time. The following important reminders will make your visit go more smoothly.

  • Do not take any supplements 24 hours before your appointment unless prescribed by a doctor or unnecessary medications for an hour before your appointment. Avoid eating one hour before your appointment.
  • Please drink a lot of water for 24 hours before your appointment. No alcohol or caffeine 12 hours before your appointment.
  • No physical activity ( yoga, competitive sports training, daily exercise routines, etc.). No therapeutic modalities ( chiropractic, acupuncture, massage, etc.).
  • Most treatments involve acupuncture points on the lower leg, forearms and back. Gowns are provided, but you may want to wear loose pants that can roll up and a white sheer shirt in place of wearing a gown. No underwire bras.
  • Please do not wear perfume, strong smelling deodorant, fragrances, essential oils, hand lotion, aftershave or cologne on the day of your visit.
  • Please bring your supplements with you, to be tested to see how well they are working for you.
  • If you need to reschedule your appointment, please do so 24 hours before your appointment.

How to Prepare for Your Distance Scanning Appointment
To ensure a smooth process, please complete the following steps carefully:

1. Collect Your Sample — Choose one of the following:

  • Saliva sample: Use 3 clean cotton swabs (Q-tips). Swab both ends of each swab thoroughly inside your mouth (cheeks, tongue, and gums).
  • Hair sample: Cut a small section of hair approximately 1 inch by 1 inch.

Place the sample in clean aluminum foil and fold it securely to protect it.

2. Prepare Supporting Materials

  • Take a clear, recent photograph of yourself from the waist up (full face and upper body visible).
  • Complete all intake forms provided to you.

3. Package and Mail Everything

Place the foil-wrapped sample, photograph, and completed intake forms in a sturdy envelope or small package. Mail them to:

  • JL Balanced Living
    Laurie Swadner
    921 Avagail Ave
    Springtown, TX 76082

4. Next Steps

Once all materials have been received, you will be contacted to schedule your appointment.

Fees

  • Initial appointment: $225
  • Follow-up appointments: $85

Payment is required at the time the appointment is scheduled. Accepted methods: cash, check, Venmo, or PayPal.

Please ensure all items are complete and properly packaged before mailing. If you have any questions, reach out prior to sending your materials.