AO Scan Intake Form

Quick and painless — about 5 minutes. This helps Dr. Laurie set up your scan profile and get the most out of your session. Booking for a pet? Just say so in the notes at the bottom!

About You

MM slash DD slash YYYY
Sex(Required)
Address(Required)
How will you be scanning?
Optional — we love saying thank you.

What Brings You In

This is the single most useful thing you can tell us.
Roughly is fine.
Optional.
Treatments, providers, remedies.
Who, and for what.
Overall, how would you rate your health?

Pertinent History

These things can influence body frequencies — short answers are perfect, and "none" or "not sure" are always fine.
Birth history
e.g., appendix, tonsils, anything significant.
Even years ago.
How much, roughly.
Breakfast / lunch / dinner / snacks & drinks.
Pregnancies, hormonal events — whatever feels relevant.

Anything Else?

Optional.
Consent(Required)
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