Client Questionnaire / Contact | Enter Balancing Rays

Client Information & Appointment Request

Please fill out the following details to help us better understand your wellness needs. Your information will remain confidential and will only be used by Enter Balancing Rays LLC.

Name *

Email address *

Address *

City, State, and Zip *

Phone Number *

New Client *

Yes
No

Scan Type *

Full Body Scan (Best Value)
Basic Plus Add-on
Parasite Scan
Basic Scan

Appointment Time *

Appointment Date *

Need special accommodations?

Pre-Scan Questionnaire

Pre-Scan Instructions: To ensure accurate biofeedback results, please follow these guidelines prior to your session: For best scan results do not eat or drink anything except water for at least 2 hours before your scan. *

I agree to the pre-scan instructions

Organs Removed (including teeth) *

Yes
No

If yes, list organs removed

Current Prescription Medications (list all):

Dietary Supplements (vitamins, herbs, etc.):

Areas of Concern (what would you like us to focus on?):

Known allergies

Have you ever been diagnosed with any medical or behavioral conditions?

Past major surgeries, injuries, or emotional traumas:

Major infections (lifetime):

Number of extreme toxic exposures per year (chemicals, radiation, etc.):

Rays Referral Program

At Enter Balancing Rays LLC, we believe that vibrant energy and holistic wellness are even better when shared. That’s why we created the Rays Referral Program — a simple, meaningful way to thank you for helping others find balance and calm through biofeedback. To find out more click the Rays Referral Button below.

Rays Referral Program