ANS Results Tool

Autonomic Nervous System Test Results Analysis

Patient Information

Vitals

Baseline (Initial Resting) - Phase A

Deep Breathing - Phase B

Valsalva - Phase D

Stand - Phase F

Clinical Notes & Observations

Patient Summary

| | Test Date:

Height: | Weight: | BMI:

Initial Baseline (Resting)

Indication of balance in the patient's ANS and protection of the heart

Deep Breathing Response

Detection of early signs of autonomic dysfunction and chronic disease

Valsalva Maneuver Response

Evaluation of baroreceptor reflex and autonomic balance

Stand Response

Indication of proper autonomic coordination and possible causes of dizziness

ANS Diagnostic Summary

Important Note: Results must be considered in the context of the patient's medical history, current medications, diagnoses, and symptoms. This tool is for data interpretation only and should not be used as a diagnosis without physician review.