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Client
FOLLOW UP FORM
and
Informed Consent
Do not use this for INITIAL BioEnergetic Scan Services. ONLY for follow-up
FOLLOW UP FORM AND CONSENT FOR BIOENERGETIC SERVICES
*
Indicates required field
Name
*
First
Last
Date of Birth
*
Tell us about your saliva swab (biological sample)
*
My practitioner is sending it to you
I am sending it to you
I am ok to proceed without a biological sample
Practitioner's Name and/or Office Name
*
Briefly Describe what has changed? What has improved? What has not improved? Has anything worsened? Any new concerns etc.....
*
Mailing address for SALIVA SWAB if you or your practitioner are sending one. Please swab the inside of your cheek with a clean cotton swab (a q-tip is fine) and place in a ziploc bag with
1. your name
2. your practitioner name/office name
3. PRACTITIONER EMAIL (NEW!!! Please include on ziploc bag or envelope)
4. your (client) date of birth.
Practitioners: we will now be notifying you by EMAIL when your client sample has arrived at the home office for testing.
Mailing address for SALIVA SWAB.
BAR, LLC
413 E Benham
Glendive MT 59330
UPDATE
Biological samples are not required at this time
if you wish, we will work off your energetic signature of your name, date of birth and location in the world.
If you would like to send a biological sample you may send your choice of a saliva swab, a hair sample, or nail clippings, but it is not required.
READ IN FULL HERE THE CLIENT INFORMED CONSENT
Consent Form
I AFFIRM I HAVE READ IN FULL THE CLIENT INFORMED CONSENT AND DISCLOSURE PROVIDED IN THE FIELD ABOVE
*
YES
TYPE YOUR FULL NAME BELOW. THIS WILL SERVE AS YOUR ELECTRONIC SIGNATURE FOR CONSENT FOR BIOENERGETIC SERVICES
*
Submit
Home
Disclaimer
Learn More
FAQ
Why Use a BioEnergetic Lab
About Our Devices
How BioEnergetic Assessments Work
Services
What's NEW for Wholesale Accounts
PEMF scans
Wholesale Services
>
Order Same Day BioEnergetic Scans
Quantum Balancing
Order Informational Assessments
>
Order Sensitvity/Allergy Panels
Order Custom BioEnergetic scans
Retail Services
What is Frequency
>
Energetic Frequency Sound Files
>
Purchase Energetic Frequency Sound Files
Private Label
Misc. Services
Practitioners
Client Initial Intake/ Consent
Client Follow Up Form / Consent
Website Tour for Wholesale Accounts
PEMF Practitioner Education
Practitioner Support
>
Next Steps
Education
Reading Reports
Practitioner Resources
Marketing Tools
Request Account
Contact Us
Affiliates
Feedback
Careers
>
Employees Only
Employee Forums