Documents & Forms
The following documents and forms are used in this office to allow us to better assit you in meeting your needs. For your convenience you may print out and complete the Initial Intake Form below and bring it to your initial visit.
Some of the other documents and/or forms below provide additional information which may assist the practitioner in developing a more comprehensive healthcare program for your particular needs. If you need to print out and/or complete any of the additional documents or forms, you will be notified when you schedule your appointment.
Intial Intake Form - This form is used to provide the clinician with all of the particulars of your current concern. Please be as complete as possible when filling out this form. During the intake the clinician will use this information as a framework for discussing your problem.
Nutrition Symptom Survey - This questionnaire is designed to assess your symptoms in light of your overall nutrition status. This form is not used as a sole means of providing a clinical disgnosis. When provided with a thorough clinical evaluation, however, it can be very helpful in identifying any underlying nutritional deficiencies or organ stress which may be benefited through various supplements.
Food Intake, Activity & Energy Record - This is a log for recording all of the different foods and drinks that you are ingesting for a given period. You can also record the various types of physical activity and exercise for which you are participating. Often we will request this information to better understand your current energy balance. We usually ask for you to maintain this log for a period of seven (7) days. You will want to be as accurate as possible while recording the requested information so we can have a better analysis of your nutritional and exercise needs.
Bach Flower Symptom Survey - This questionnaire is used to as a general assessment tool for your overall emotional state. Since much of our health is manifested in the degree of stress we are under, it is helpful for the clinician to have a good picture of this aspect of your health. If necessary we may recommend Bach Flower Remedies or other emotional support modalities for any issues that we may feel would otherwise hinder your full recovery.
Par-Q and You - This is a good basic screening tool to assess if physical activity or exercise is appropriate to your current health status. Yes replys to the survey should prompt you to seek further clearance from you primary care provider before undertaking any exercise program.
Finding the Time - This tool is helpful in helping those individuals who find it hard to find time to exercise or if at the end of the day they are questioning where their time went. It is especially useful to see how you are spending your day and how best to fit in one more thing... exercise.
Float Tank Use and Safety - This document will give you some good information about the float tank and some basic safety or health precausion. And, while use of float tanks are safe for most everyone, this document also contains a list of contraindications for floating.