Describe any significant history concerning your physical body (include any accident, medical intervention, medication, symptoms, toxin or drug exposure)
Describe any significant history concerning your mental and emotional life (include any major life stresses, traumas or events, as well as any medications or mental & emotional symptoms)
How is your mental and emotional life presently? Please include any current mental health challenges, diagnoses and medications)
What would your main goal/s for the future be for your mental and emotional life?
Do you consume alcohol, coffee or refined sugars? If yes, how often for each?
What type of practitioners and health care providers have you consulted in the past and how helpful have they been?
Who do you have on your health team presently, and how long have you been seeing them for?
Is there any other information which you feel may be relevant to your care here that has not been covered?
By signing this form, you are stating that you give consent for our practitioners to treat you using the Spinal Energetics technique. This technique is a gently/no touch energy healing technique that unwinds tension patterns along the spine in a safe and gentle way to release past trauma, reduce stress and increase your overall quality of life.