Evaluation Checklist

We have provided you with a checklist for your evaluation paperwork. We

ask that you please be detailed and thorough in completing it. After you
have completed each section please initial where instructed:

Initial Here
Form #1: The BAX 3000 Allergy Elimination System
How it Works… (2 pages)

Initial Here
Form #2: Intake Questionnaire… (5 pages)

Initial Here Form #3: Your First Visit, What to Expect… (4 pages)

Initial Here
BAX Patient Introduction Video (Main video located
on www.BioVedaofEastCentennial.com... please view the
entire video prior to your initial visit)

Thank You!

Maximized Health Allergy Relief Center

T: 303.462.4476 • F: 303.221.2790
www.BioVedaofEastCentennial.com
 How Does the BAX-3000 Work?
A Better Understanding of Allergy Symptoms and Treatment

Allergies are nothing more than an inappropriate response to something that is perfectly harmless. Your body sees
an ordinary substance as foreign and attacks it sending you into an allergic reaction of red, itchy eyes, a scratchy
throat and trouble breathing. It is essentially a neurological error in the body's immune system where it does
anything it can to combat this "bad, foreign" substance. But, this substance is perfectly harmless. What's worse is
now a new association is turned into an engrained pathway in your nervous system which will associate that
substance as a foreign object from there on out. It is a substance/association error that is made and learned by
your nervous system. An example of this is when you eat a normally harmless food and it makes you sick
afterwards (eggs for example). You get sick and you know what happens (no details necessary here). Your body
will associate the sickness with the food that you ate so that, most likely, even months to years down the road the
sight or smell of eggs will make you nauseous and even a little sick. But eggs are not the problem; it's the incorrect
association that your nervous system has made - that's the problem!

How Do You Know What You Are Allergic To?

Each specific allergen has its own specific frequency. Every chemical does – it’s like an electrical fingerprint. Cat
dander for example has a certain frequency. Dust has a specific frequency that is different than cat dander. These
frequencies plus 100's of thousands of other frequencies of possible allergens are introduced safely into the body
over several sessions. The body is then monitored to see which frequencies cause it to go into allergic reaction.
Then a complete list of all the frequencies (allergens) that caused the body to go into allergic reaction is made
giving you a complete list of everything you are allergic to in that particular session. The average person will have
5-20 different allergens.

Why is this New Approach better than the Old Approach?

This new approach to allergy symptoms is very similar to the allergy scratch test and allergy shot treatment
approach, but with several unique advantages: no chemicals or needles are used, the number of allergens tested is
significantly greater, the accuracy of the diagnosis is much higher – thereby, increasing the accuracy of the
treatment. And, unlike allergy shots that often have many side effects, this approach is safe – even for small
children. The best part, this is a neurologically based approach, which means the body has an easier time
accepting it – as opposed to needles and medications.

How Do You Fix These Allergy Symptoms… Permanently!

In order to eliminate and rid you of your allergy symptoms, each of these frequencies (allergens) will be introduced
back into the body one at a time, each on different days. For example if milk allergies are to be eliminated first
then on session # 1 the computer will introduce the frequency for milk into the body. Then, and this is the best part,
as that frequency (allergen) is painlessly introduced into the body the Class II Laser Technology stimulates specific
nerve bundles and certain acupuncture points which releases endorphins and
other relaxing, feel good chemicals. So instead of that frequency (milk) causing
you to go into allergic reaction, the laser retrains the nervous system to respond
normally when you drink milk instead of an upset stomach, runny nose, etc.
This new nervous system pathway permanently replaces the old pathway, like a
newly formatted computer program, thus permanently ridding you of that specific allergen. Once all the pathways
are retrained for each allergen you can say good bye to allergy pills, shots, and allergy related red, swollen eyes,
scratchy throats and runny noses.

A Great Analogy for You to Think About!

We already pointed out that the allergy symptoms and the allergy response is initiated by a learned neurological
error, like a bad habit or a bad reflex. Therefore, in order to truly fix the problem at its source we must eliminate
the neurological error. Below are some examples of this principle in action that you may better relate to.

Addressing allergy symptoms, asthma symptoms and food sensitivities with “neurological reprogramming” using
the BAX-3000 Laser Technology is like:

1. A computer programmer cleaning your hard drive of program errors and reformatting it to run with optimal
efficiency and accuracy.

Using the BAX-3000 is like:

2. An electrician that can pin point with great accuracy where the faulty wiring problem is and correct it so the
thing that did not work properly can begin working perfectly again.

Using the BAX-3000 is like:

3. A doctor, who instead of treating only the patient’s symptoms, finds the root cause and treats it directly,
thereby granting the patient longer lasting improvement.

After reading this, one must ask…

What is the best way to address symptoms related to allergies, asthma, IBS, chronic fatigue, etc? Is it to medicate
the symptoms and leave the patient with a condition that they must ‘learn to live with’?

Or, is it to detect and correct the underlying neurological error that is responsible for the abnormal immune system
response, and correct that error with a system of treatment that best matches the actual problem… one that is safer
and more effective?

The answer is obvious isn’t it?

To learn more about the BAX-3000 Laser Allergy System, available in your area exclusively at Maximized Health
Allergy Relief Center in Centennial, call 303-462-4476. The office is located at 7323 S. Alton Way, Suite B
Centennial, CO 80112. The web address is www.biovedaofeastcentennial.com.
Call now to schedule your consultation and assessment.
 INTAKE QUESTIONNAIRE

Patient Name: Date:

Address: Date of Birth:
City, State, Zip: Home #:
Email: Mobile #:
Gender (circle one): MALE FEMALE Work #:
Referred By: _____________________ If you were not referred to us, how did you hear about us? _________________

Primary Care Physician: Physician’s Phone #:

Patient herby authorizes Maximized Health to furnish a full report regarding your case history and the results of your
treatments to Primary Care/ Referring Physician
____________________________________
Signature

Although your history and symptoms are very important in our analysis of your condition, it is also important for
us that you understand:
• We do not treat symptoms or diseases.
• A symptom is an attempt by your body to tell you something.
• We will attempt to find the underlying cause.
• We do not use drugs in this program.
• There is no single “healthy” diet that will work for everyone.
• Just because food is considered “healthy”, does not mean it is “healthy” for you.
• Your diet consists of everything you eat, drink, rub on your skin, or inhale.
• Our procedures are safe and painless.

Briefly describe the reason for your visit and what you hope to accomplish:

AGE WHEN SYMPTOMS WERE FIRST OBSERVED

 Infant (Age 0-2)  Child (Age 3-5)
 Child (Age 6-12)  Adolescent (Age 13-18)
 Adult (Age 19-25)  Adult (Age 26-40)
 Adult (Age 41 and over)

Tell us about your Vaccinations:

 Standard Child Vaccinations  Vaccinations were not preformed
 Adult Vaccinations (Please Describe) ______________________________________________________________________________________________
 Military Vaccinations (Please Describe) ___________________________________________________________________________________________
Any other Vaccinations? __________________________________________________________________________________________________________

Maximized Health Allergy Relief Center

T: 303.462.4476 • F: 303.221.2790
www.BioVedaOfEastCentennial.com Patient Id #__________
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DID YOU SUFFER FROM ANY TYPE OF PHYSICAL, CHEMICAL OR EMOTIONAL TRAUMA JUST
BEFORE YOUR SYMPTOMS WERE FIRST OBSERVED?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

HAVE YOUR SYMPTOMS EVER GONE AWAY FOR ANY PERIOD OF TIME?

__________________________________________________________________________________________________

__________________________________________________________________________________________________
FAMILY MEMBERS WITH SIMILAR SYMPTOMS
Mother Father
Brother/Sister Grandparents
Son/Daughter Spouse
None

FREQUENCY & SEVERITY OF SYMPTOMS

Constant/Chronic with little change Present most of the time
Present part of the time Present rarely
Prevents some normal activities Considerable interference with normal life
Slight interference with normal life No interference with normal life

SYMPTOMS ARE WORSE

Outdoors and better indoors At nighttime
In the bedroom or when in bed During windy weather
During wet or damp weather When the weather changes
During known pollen seasons In certain rooms or buildings
When exposed to tobacco smoke With yard work, cut grass, leaves, hay or barns
When sweeping or dusting the house In areas with mold or mildew
In air conditioning In fields or in the country
Tobacco smoke bothers me more than anything else

SYMPTOMS ARE BETTER

After shower or bath In air conditioning
Indoors During or after physical activity
After taking antihistamines With allergy shots

What makes you feel better?

__________________________________________________________________________________________________

Maximized Health Allergy Relief Center

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ANIMALS, INSECTS AND BIRDS THAT CAUSE SYMPTOMS ON EXPOSURE
Dogs Cats Rodents (mice, guinea pigs, etc.)
Horses or Cattle Rabbits Birds or Feathers
Bees Other

FOOD RELATED SYMPTOMS

Symptoms flare 5-60 minutes after meals Some foods are craved or addictive
The smell or odor of some foods increases symptoms Some foods cause nasal symptoms
Some foods cause swelling of the mouth or tongue Some foods cause rashes or hives
Some foods cause upset stomach or vomiting Some foods cause diarrhea
Symptoms occur with restaurant salad bars or Asian foods Some foods cause headaches
Symptoms occur with any regularly eaten food Some foods cause asthma
Preservatives, additives or food coloring increase symptoms No problem with foods

FOODS THAT CAUSE SYMPTOMS FROM ONE HOUR TO THREE DAYS AFTER EXPOSURE
Eggs Milk Beef
Corn Wheat Soybean
Peanut Pork Fish
Shellfish Orange or other citrus Potato
Tomato Yeast Chocolate
Coffee or Tea Other
None

CHEMICALS THAT CAUSE SYMPTOMS

Insecticides & pesticides Paints & household cleaners
Perfumes & cosmetics Gasoline or automobiles exhaust
Stove or furnace emissions The smell of new fabrics or fabric store
Chemicals in the workplace Laundry detergent
Newsprint Other:
None

WHEN ARE YOUR SYMPTOMS WORSE Year around

January February March April
May June July August
September October November December

MEDICATIONS
Do you take any of the following medications on a regular basis?
Antihistamines (Benadryl, Actifed, Chlortrimeton, Tylenol Sinus, Tylenol Sleep, Dimetapp,Drixoral, Trimalin,
Atarax, Claritin, Allegra, Zyrtec, etc)
Bronchodilators (Albuterol, Ventolin, Proventil, Serevent, or OTS’s such as Primatine Mist, etc)
Steroid Inhalers (Asmacort, Flovent, Pulmicort, Beclovent, Aerobid, Advair, etc)
Nasal Steroids (Beconase, Flonase, Nasacort, Rhinocort, etc)

Maximized Health Allergy Relief Center

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www.BioVedaOfEastCentennial.com
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 Medications that affect the immune system (Prednisone, Imuran, Methotrexate, Cellcept, Cyclosporine,
Tacrolimus, etc)
Chemotherapy
Please list any medications that you are currently taking:

SMOKING
Do you presently smoke? Yes No If yes, average number of cigarettes per day
If yes, at what age did you start?
Does anyone smoke in your home? Yes No

PREVIOUS ALLERGY EVALUTION

Have you ever seen an allergist? Yes No
Have you had allergy skin testing? Yes No
Did you have any positive reaction? Yes No
If yes, please list positive allergens (include any medications)
Have you ever received allergy injections? Yes No

WORK ENVIRONMENT
What is your occupation?
Are you exposed to chemicals or strong odors at work? Yes No
If yes, briefly explain

Are you symptoms worse while at work? Yes No

If yes, briefly explain

ANY ADDITIONAL INFORMATION YOU WOULD LIKE US TO KNOW?

ANYTHING ELSE YOU WOULD LIKE TO ASK?

Maximized Health Allergy Relief Center

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www.BioVedaOfEastCentennial.com
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PLEASE CHECK OFF THE FOLLOWING THAT APPLY TO YOU:

Digestive Track Joints & Muscles Nose

__nausea & vomiting __pains/aches in joints __stuffy nose
__diarrhea __arthritis/osteoarthritis __chronically red/inflamed nose
__constipation __stiffness/limited movement __sinus problems
__bloated feeling __pain/aches in muscles __hay fever
__stomach pains or cramps __feeling weak/tired __sneezing attacks
__heart burn __swollen/tender joints __excessive mucous formation
__blood and/or mucous in stools __growing pains in legs
__Psoriatic/Gouty Arthritis S Skin
__Rheumatoid Arthritis S __acne
Ears __itching
__itchy ears Lungs __hives/rash/dry skin
__ear aches/ear infections __chest congestion __hair loss
__drainage from ear __bronchitis __flushing/hot flashes
__ringing in ears __shortness of breath
__hearing loss __difficulty breathing Weight
__reddening of ears __persistent cough __binge eating/drinking
__wheezing __craving certain foods
__excessive weight
Emotions __compulsive eating
__mood swings __water retention
__anxiety/fear/nervousness Mind
__anger/irritability/aggressiveness __poor memory General
__argumentative __difficulty completing projects __frequent illness
__frustrated/cries easily __difficulty with mathematics __frequent/urgent urination
__Depression S __underachiever __genital itch/discharge
__poor/short attention span __anal itching
__confusion
__easily distracted Genitourinary
Eyes __difficulty making decisions __kidney problems
__watery or itchy eyes __mild learning Disabilities __urinary tract
__red/swollen/itchy eyelids __bladder
__bags or dark circles under eyes __yeast infections
__blurred or tunnel vision Mouth & Throat Thrush
__chronic coughing Other Conditions
__gagging/clearing throat often __Autism S
Head __sore throat/hoarse voice/voice __A.D.H.D. S
__headaches loss __A.D.D. S
__faintness __swollen/discolored tongue/lips __Psoriasis S
__dizziness __canker sores __Eczema S
__insomnia/sleep disorder __itching on roof of mouth __Auto Immune Disorder S
__facial flushing __Chronic Fatigue S
__Multiple Chemical Sensitivities S
__Asthma S
Heart __Congestive Heart Failure S
__Irregular/Skipped Heartbeat S __Severe Diabetic S
__Rapid/Pounding Heartbeat S __Severe Depression S
__Chest Pain S __Obsessive Compulsive Disorder S

Maximized Health Allergy Relief Center

T: 303.462.4476 • F: 303.221.2790
www.BioVedaOfEastCentennial.com
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 Your First Visit, What to Expect...
Welcome to Maximized Health Allergy Relief Center, a BioVeda Health and Wellness
Center. You have taken the first step in experiencing our revolutionary new alternative
therapy for NSRTSM or Neurological Stress Reduction Therapy. Our goal is to provide
you with the right expectations for your care and the information you’ll need to make
an informed decision about whether this therapy is right for you.

Because every individual is unique, we do not have “Standard” care plans. What we
can do however is set an expectation for your first few visits and the treatment plan
that would be implemented based on the severity of your condition and general state of
health and wellness.

FIRST VISIT OVERVIEW

Time: 60 Minutes

System Balance

Your first visit starts with a System Balance treatment. The System Balance is a general
de-stressor that calms your body allowing us to get the most accurate assessment and
substance specific stress readings. You must wait approximately 30-45 minutes from
the completion of the System Balance to the start of the assessment. Upon arriving at
the office, we will start with the System Balance and then complete your Patient
Medical History.

Patient Medical History

It’s important for us to understand any symptoms or conditions that you may be
experiencing, any medical diagnosis that has been provided previously by your family
doctor, medications you currently use periodically or regularly, any lab tests, surgery or
hospital visits you’ve had recently as well as your family history. This is also the time
where we set goals for your care and determine what you want to get out of therapy.

Hypersensitivity Assessment

Following a review of your medical history, if appropriate, we will perform the

neurological substance specific stress assessment for all items in Group One. Group
One contains the items that are most often the triggers for the conditions you are
experiencing. This is not an allergy test but an assessment of which substances you
are deficient in, which substances your body has trouble absorbing and which
substances your body may inappropriately believe are toxins. If it is determined from
Maximized Health Allergy Relief Center
T: 303.462.4476 • F: 303.221.2790
www.BioVedaofEastCentennial.com
1 – Patient Copy
your medical history that the assessment will be too stressful to your system the
assessment will not be done and we can proceed directly to treating Group One items.

Care Plan Explanation & Financial Consultation

Following your assessment which will take approximately 10-15 minutes, we will review
the results. The Group One procedure is critical for the patient because these
substances are typically the underlying cause for most symptoms and conditions.
Patients that complete Group One and have known environmental or food allergies
often experience an elimination of the symptoms without being treated for the specific
“allergen”. If the symptoms persist a second assessment will be done for Group Two,
Three, or Four which target environmental substances and foods. The order of
assessment and treatment of Group Two, Three and Four substances can be altered
based on your symptoms and known substance sensitivities.

Care Plans are divided into Mild, Moderate and Severe Protocols. The history and
assessment dictates which category you fall into based on which substances as well as
how many substances require therapy.

LASERSM Therapy
Time: 5 Minutes

LASERSM is the acronym for our proprietary Light and Sound Energy Relaxation
technique. Following your first visit, each ensuing visit’s therapy time will be 2-3
minutes during which the laser will be applied down your back and along your allergy
meridians. Additional time is allotted for short discussion about your experience and
symptomatic relief.

Each therapy session will focus on a single group of substances. You may visit the
clinic every other day for therapy. You may not eat for 1 hour prior to therapy and we
suggest you schedule your therapy so you can avoid the foods and substances
necessary for the conditioning process to work, please refer to “Items to Avoid”
handout. Many patients come in the afternoon or on a day off so they can go home
and get a good night’s sleep and avoid places with strong odors, chemicals and foods.
While most patients feel nothing and experience no side effects following therapy, some
patients do report a tingling sensation, slight sinus congestion or slight redness and
itching. These are good signs that the therapy is working and part of the body’s
detoxification process. This usually lasts no more than a few hours.

**** Same as cash financing for 12 months is available with approved credit

Maximized Health Allergy Relief Center

T: 303.462.4476 • F: 303.221.2790
www.BioVedaofEastCentennial.com
2 – Patient Copy
 The day of your appointment:

Our testing is performed on a strict time schedule, so please be on time. The

following reminders will help make your visit go more smoothly.

Do not take any supplements or unnecessary medications for four hours before
your appointment.

Please drink a lot of water for 24 hours before your visit. We will need you to be
well hydrated.

A white single layer shirt is required for your treatment, a shirt will be provided
for you if needed.

Do not wear pantyhose or clothes with very tight sleeves, as they will interfere
with the testing procedures.

Do not wear any jewelry. You may wear your wedding ring.

Please do not take any aspirin or pain medication for 12 hours before being tested,
if possible.

Do not consume alcohol for 12 hours before your appointment.

Please do not wear perfume, strong smelling deodorant, fragrances, essential oils,
hand lotion, aftershave or cologne on the day of your visit. (before or after).

Please schedule appointment so that you are not being tested during the first three
days of your menstrual cycle.

If you need to reschedule your appointment, please do so no later than noon

two (2) business days prior to your appointment to avoid a cancellation fee.

We may be performing several tests during your visit. You will be filling out an
extensive questionnaire and speaking with the doctor. Expect to be here at least
one hour.

At the end of your visit you may be given some instructions and a list of foods to
avoid for 24 hours.

Please eat before your appointment. You may be asked to avoid food for a short
time after your visit or to eat very little. Do not come to your appointment hungry.

Maximized Health Allergy Relief Center

T: 303.462.4476 • F: 303.221.2790
www.BioVedaOfEastCentennial.com
If you receive a treatment on the first visit:

You may not shop for eight hours after the visit. So please shop in advance of
your visit.

You may not go to a restaurant for eight hours. (for any reason)

You may not visit a hair salon, barber shop, or nail salon for twelve hours after
being treated.

You must avoid all chemicals for twelve hours, so please refuel your automobile
before your visit.

You may not bathe or shower for eight hours after treatment, so please shower
before your visit.

Do not chew gum, use breath mints, drink anything except water or eat anything
after arriving for your visit.

Not permitted for twelve hours after treatment: Chiropractic Adjustments,

Massage, Acupuncture, Vigorous Exercise, Hot Tub, Sauna, Steam Room or
Swimming. These things should be done before your visit, not afterwards.

You may not consume alcohol for twelve hours after treatment.

Do not eat a large meal after treatment.

You may be given a list of additional things to avoid for 24 hours after treatment.

The restrictions above are designed for the worst case scenario.

We have designed these suggestions based on years of practical experience. You may be
able to break some or all of the rules and do just fine, or you may bend one rule and have
to repeat the visit. You will have the best chance for success if you follow all the
suggestions. The restrictions are to be followed for 24 hours, a small price to pay for a
long term benefit.

Maximized Health Allergy Relief Center

T: 303.462.4476 • F: 303.221.2790
www.BioVedaOfEastCentennial.com