Hair and Nail Sample – How to Collect and Send

Hair - Brush hair and collect 3 – 4 strands from fallout while brushing. You can also cut 3 or 4 strands from head if you can’t get any by brushing. Place collected samples in a Ziploc bag labeled with your name, birth date, and collection date on the bag. *If you don’t have much or any hair on the head, add more nail clippings (see below).

Also, in the same bag …

Nails – Cut some fingernails or toenails. Only 2 – 3 clippings are needed. Place the clippings in the same Ziploc bag as the hair. ***If you have gel nails, they cannot be used. Just place a bit more hair in the Ziplock bag.

***Swab – If there is no hair to use and you have gel nails, you can take a Q-tip and swab the inside of your cheek first thing in the morning. Place the swab in the Ziplock bag along with any other samples you may have taken or by itself.

ALL SAMPLES CAN BE SENT IN THE SAME ZIPLOCK BAG! Please do not wrap samples up in tissue or anything else - just place in bag.

Send – Ziplock bag with samples can be placed in a regular envelope. If you are in Roanoke, VA, samples can be dropped off at the UPS Store in front of Montano’s in Roanoke, VA. Please clearly mark the envelope Total You Health and #110. If you are outside of Roanoke, VA, please mail to: Total You Health; 3735 Franklin Rd. SW, #110, Roanoke, VA 24014.

***Please note – Total You Health needs a 30-day notice provided by the client to discontinue the 3-month program.

Total You Health Intake Form

Please fill this form out before your initial visit.

WELCOME

First Name *

Last Name *

Today's Date *

Phone *

Email *

Address

Date of birth *

Emergency Contact Information - (Name, Relationship, & Phone Number) *

What diagnoses do you have?

Please describe your current state of health & the primary reason/s for your scan. - Including diagnoses & length of time of the condition.

Please rank where you believe your Overall Health stands- (1= Low Health, 10= Very Healthy)

Do you have pain?

If yes, is it all-over body pain or in a certain area?

Please rank your pain below: (1= low pain; 10= most pain)

Do you have low energy?

Please rank your energy level: (1= low energy; 10= most energy)

Are you mentally clear?

Please rank your mental clarity: (1= least clear; 10= most clear)

Do you have anxiety?

Please rank your anxiety: (1= low anxiety; 10= most anxiety)

Do you experience depression?

Please rank your depression: (1= low depression; 10= most depressed)

Do you have sleep issues?

Please rank your sleep: (1= low sleep; 10= best sleep)

Do you experience digestive issues?

Please rank your digestion: (1= no digestive issues; 10= most digestive issues)

Do you have allergies?

Please rank your allergies: (1= no allergies; 10= most allergy symptoms)

Do you experience stress?

Please rank your stress: (1= no stress; 10= most stress)

Is there anything else you would like us to know about you?

I am interested in Health Coaching.

Yes

I would like more information

Total You Health® Body Balance Testing Service Agreement

1. Introduction

Welcome to Total You Health® Body Balance Testing. This Service Agreement (“Agreement”) outlines the terms and conditions under which you ("Client") agree to participate in the Body Balance Testing services provided by Total You Health®("Provider"). By agreeing to these terms, you acknowledge that you have read, understood, and agree to be bound by the terms and conditions of this Agreement.

2. Services Provided

Total You Health® offers Body Balance Testing services, which could include but are not limited to:

Remedies customized to the client's needs

Report of findings and testing results

Recommendations for lifestyle and dietary adjustments

Follow-up consultations and progress tracking

3. Client Responsibilities

As a Client, you agree to:

Provide accurate and complete information about your health, medical history, and lifestyle as requested by the Provider.

Follow the instructions provided to send collected samples prior to testing to ensure accurate results.

Attend scheduled appointments or notify the Provider in advance if you need to reschedule.

Follow the health and wellness recommendations provided by the Provider to the best of your ability.

4. Confidentiality

Total You Health® is committed to maintaining the confidentiality of your personal and health information. All data collected during the testing process will be used solely for the purpose of providing you with personalized health recommendations and will not be shared with third parties without your explicit consent, except as required by law.

5. Payment and Fees

The Client agrees to pay all fees associated with the Body Balance Testing services as outlined in the payment schedule provided by Total You Health®.

Payments are due at the time invoice is sent.

Total You Health® reserves the right to change its prices at any time, with prior notice to the Client.

6. Cancellation and Refund Policy

Clients must provide at least 24 hours' notice for cancellations or rescheduling of calls.

Refunds for services rendered will not be provided.

7. Disclaimer and Limitation of Liability

Total You Health's® Body Balance Testing services are intended to provide insights into your health and wellness. These services are not a substitute for professional medical advice, diagnosis, or treatment.

The Provider makes no guarantees regarding the accuracy of the testing results or the effectiveness of the recommendations provided.

The Client agrees to release and hold harmless Total You Health®, its employees, and agents from any and all claims, damages, or liabilities arising out of or in connection with the use of the services provided.

8. Use of Testimonials and Communications

By agreeing to this Agreement, the Client grants Total You Health® permission to use their testimonials, stories, emails, texts, or reviews for promotional and marketing purposes. This includes but is not limited to:

Publishing testimonials on the Provider’s website, social media platforms, and other marketing materials.

Using excerpts from communications to illustrate client experiences and the benefits of the services provided.

Total You Health® agrees to use these materials respectfully and will not disclose any personal information that could identify the Client without obtaining additional explicit consent.

9. Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction in which Total You Health® operates.

10. Entire Agreement

This Agreement constitutes the entire agreement between the Client and Total You Health® regarding the Body Balance Testing services and supersedes any prior agreements or understandings, whether written or oral.

11. Amendments

Total You Health® reserves the right to amend this Agreement at any time. The Client will be notified of any significant changes and will have the option to accept the revised terms or discontinue the use of the services.

12. Acceptance of Terms

By agreeing to these terms and conditions, the Client acknowledges that they have read, understood, and agree to be bound by this Service Agreement.

Body Balance Testing Consent

Body Balance testing provides a completely non-invasive method for gaining valuable information about your bodies vital functions. The primary objective of the screening is to disclose patterns of stress and provide feedback that will assist in developing a program to restore each system and meridian to balance.

I understand that this testing does not provide medical diagnosis and that my testing technician may recommend further medical testing. If I suspect I need further medical intervention, I understand I should consult MY physician. I give permission for the testing technician to evaluate me using Body Balance testing.

I understand in doing so my testing technician is not becoming my primary care physician. I understand that the testing technician will give me information about myself and make recommendations based on the testing. I understand that the testing technician will not pass judgments on prescribed medications and it is the responsibility of my primary care physician to make any adjustments on prescribed medications. Any

decision to follow through with the recommended program is my own decision, and I hold the testing technician harmless.

I understand that I am here to learn about natural health and better lifestyle practices, and I will be offered information about food, supplements, and herbs as a guide to general health.

I understand that I should continue to see any medical doctors I am currently under the care of and that any prescribed medication should not be altered without first consulting the physician who recommen-ed it.

I fully understand that those who counsel me are not medical doctors, medical practitioners, licensed nutritionists, or licensed naturopaths. I am not here for any medical diagnostic purposes or treatment procedures.

Information about traditional uses of supplementation that may create a healthy balance in the body may be discussed. This is not intended to be interpreted as a substitute for a licensed physician treatment.

Nothing said, done, typed, printed, or reproduced by us is

intended to diagnose, prescribe, treat, or take the place of a licensed physician.

The intent is to provide educational information for the purpose of assisting the client

with the lifestyle changes necessary to regain and maintain an environment needed to

support a well-balanced lifestyle.

I am not on this visit, or any subsequent visit, acting as an agent for the federal, state,

county, or local law enforcement or news media on a mission of entrapment or investigation. I understand that all information and conversations will be kept confidential, and that

information concerning myself can be released to another health professional only with

my written consent.

I understand that the Body Balance testing will only identify imbalances and does not diagnose any diseases in the body. The balancing item refers to the energetic signature needed to restore balance to the body. Balancing items are defined differently from medical terms and are not a cure for any disease.

I recognize that Body Balance testing is an unorthodox approach to balancing my health. Being of sound mind, I have chosen this screening to assist in balancing my health of my own free will and an exercise of my constitutional right for the attainment of life, liberty, and the pursuit of happiness.

I agree to all the terms & conditions provided by the company. All information I provided is correct. By providing my phone number, I agree to receive text messages from the business.

My signature of record

Clear