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  • New client health intake form

    Thank you for completing this form prior to your first Spinal Flow session. Please know any personal information shared is kept strictly confidential and used only to support your healing journey. There are no right or wrong answers. The information you choose to share about you will uncover the layers of damage so I can understand and support you in the areas you want and need the most.

  • About your health

    The human body is designed to be healthy and our bodies have an innnate wisdom to heal itself.  Throughout life, events occur which damage your health and our body's ability to heal.

    Physical, emotional and chemical stressors are unavoidable and each one of these stressors could potentially leave layers of damage creating blockages along your spine.

    This questionnaire is designed to uncover the layers of damage, especially to your nervous system, resulting in pain, dis-ease and/or poor health.

  • Loss of wellness (Birth-age 5)

    Lets begin at birth when you may have first experienced stress that affected your nervous system

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  • Loss of whole body health (Age 5 - present)

    As you increase the layers of damage you begin to experience symptoms and random bouts of sickness.

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  • PHYSICAL AND EMOTIONAL STRESSORS

  • Present state of health (symptoms)

    The years of continuing damage can then show up as acute or chronic symptoms

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  • Client Declaration

    By signing this form, I agree and consent to receiving Spinal Flow.

    Spinal Flow Technique offers a genuine approach to wellness. The aim of our health care is not to treat your symptoms, but to get to the cause of your problem and correct it properly. This is done through natural means, without the use of drugs or surgery.

    • I understand that with any healing process and work on my body, my symptoms may worsen before they get better.
    • I understand this program is designed to assist the body with healing by helping to remove stressors from the body.
    • I understand that healing takes time and there is no quick immediate fix to my problem, and health is a process.
    • I have freely decided to undergo the recommended treatment and hereby give my full consent to treatment.
    • I take full responsibility for my own health and that the treatment I receive is in no way intended to be a substitute for professional medical advice, diagnosis, or treatment.
    • I understand that I should continue to see my medical doctors I am currently under the care of, and that any prescription medication should not be altered without first consulting the doctor who recommended it.
    • Cancellations with 24 hours of your appointment may incur a cancellation fee.
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