AO Scan Waiver Form and Questionnaire

AO BIORESONANCE SCAN FORM
Sign the Waiver
AO Scan Mobile Consultation Consent Agreement and Liability Waiver

Get2TheRoots: Spirit, Soul & Body Restoration
AO Scan Technology Use, Client Acknowledgment, and Full Liability Waiver

Dear Valued Client,

Welcome to Get2TheRoots: Spirit, Soul & Body Restoration!

Before we begin your AO Scan session or grant access to your AO Pass, please take a few moments to review and complete this Client Waiver. This document ensures that you understand the nature of the services being provided, clarifies the purpose of AO Scan technology, and confirms your agreement to participate voluntarily.
Once completed, please return this signed form prior to your session or AO Pass activation.

Thank you for taking this important step in your personal wellness journey!

With gratitude,
Lee Mauldin, CHHP
Founder, Get2TheRoots: Spirit, Soul & Body Restoration

Client Acknowledgment and Full Liability Waiver
IMPORTANT: Please read each statement carefully. Initial each line to confirm your full understanding and agreement.
Participant*
Independent Quantum Living Advocate*
1. ______ I acknowledge that Lee Mauldin, CHHP, is a Certified Holistic Health Practitioner offering education and wellness services. She is NOT a licensed physician, healthcare provider, or mental health counselor.*
INITIAL HERE
2. ______ I understand that the AO Scan technology and/or AO Pass access provided is for personal education and informational purposes only, and is NOT intended to diagnose, treat, cure, or prevent any disease, condition, or mental or emotional disorder.*
INITIAL HERE
3. ______ I understand that no diagnosing, treating, prescribing, curing, or medical advice are provided during or after the use of AO Scan services.*
INITIAL HERE
4. ______ I acknowledge that AO Scan technology is an energetic wellness tool designed to detect and measure frequency imbalances. It is not a substitute for any form of medical evaluation, therapy, or intervention.*
INITIAL HERE
5. ______ I understand that AO Scan technology and similar frequency-based modalities are considered innovative and are not recognized by conventional medical standards, and that statements made regarding these services have not been evaluated by the U.S. Food andDrug Administration (FDA).*
INITIAL HERE
6. ______ I fully accept that no guarantees are made regarding outcomes, and that I am fully responsible for all decisions regarding my personal health and wellness.*
INITIAL HERE
7. ______ I understand that payment for any services or access to technology is paid prior to the time of service, unless otherwise arranged in writing prior to the session.*
INITIAL HERE
8. ______ I affirm that I am participating voluntarily, under the dictates of my own conscience, and not under duress or coercion.*
INITIAL HERE
9. ______ I affirm that I am not representing nor acting as an agent for any medical board, regulatory agency, legal entity, or government body.*
INITIAL HERE
10. ______ I affirm that I am requesting this service for my own personal wellness journey, and NOT for the purpose of investigation, litigation, or legal recourse.*
INITIAL HERE
11. ______ I agree to release, waive, and forever discharge Lee Mauldin, CHHP, andGet2TheRoots: Spirit, Soul & Body Restoration, as well as their heirs, executors,administrators, and assigns, from any and all claims, demands, causes of action, damages, or liabilities arising out of or related to my participation in AO Scan services or use of AO Pass.*
12. ______ I acknowledge that participation involves no known physical risk but affirm that I accept all responsibility for my health decisions and participate fully at my own risk.*
13. ______ I confirm that I am of legal age in my jurisdiction or have obtained parental or legal guardian consent if under the age of 18.*
Optional Review of AO Scan Reports
14. ______ I understand that any review, explanation, or discussion of AO Scan results with Lee Mauldin, CHHP, is provided solely for educational purposes and is not intended to diagnose, treat, prescribe, cure, or offer medical advice of any kind.*
15. ______ I acknowledge that any insights shared during a report review are for informational use only and are not a substitute for professional medical, psychological, or mental health care.*
Final Acknowledgment: By signing below, I acknowledge that I have carefully read, fully understand, and agree to each statement above. I accept full and complete responsibility for my participation, and I freely assume all risks associated with my use of these services and technology.*
INITIAL HERE
Please initial each line, indicating that you have read, understand, and agree with the statement.
Printed Name*
Signature*

Powered by Jotform SignClear
Parent Guardian Relationship if under 18 years of age*
Date*

MonthDayYear
Date
CONTACT INFORMATION:

Get2TheRoots, Spirit, Soul and Body Restoration

WEBSITE: get2theroots.com

EMAIL: get2theroots@gmail.com

INNER VOICE SCAN QUESTIONNAIRE FORM
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
What is your height in inches?*
What is your weight in pounds?*
Please include a 12-second voice recording. Saying 'I AM', state your full name, then talk for 12 seconds telling something about yourself and whatever else you would like to add or say.
Voice Recorder*
Please upload a recent picture of yourself. Please make sure it in color, that it has a neutral background, no hats or glasses, you are the only one in the photo, the picture should be shoulders up and you are looking directly at the camera. Thank You*

Cancelof
CONTACT INFORMATION:

Get2TheRoots, Spirit, Soul and Body Restoration

WEBSITE: get2theroots.com

EMAIL: get2theroots@gmail.com
Should be Empty:

AO BIORESONANCE SCAN FORM

Sign the Waiver

Optional Review of AO Scan Reports

INNER VOICE SCAN QUESTIONNAIRE FORM

Please include a 12-second voice recording. Saying 'I AM', state your full name, then talk for 12 seconds telling something about yourself and whatever else you would like to add or say.