Biodynamic CranioSacral Initial Form

About Your Session

Biodynamic Craniosacral Therapy can lead to changes in areas of restriction and discomfort within the body. It is a subtle yet profound healing modality which assists the bodies’ capacity for self-repair. Each person has their own unique experiences in life and our bodies register these experiences, thoughts and feelings. It is with the assistance of the practitioner that your own “inner physician” seeks to reorganise and find balance. Our bodies naturally want to realign themselves with health and this therapy helps our bodies to tap into its own innate wisdom to create balance and health.

Full name:

Are you having problems with any of the following? Please tick.
HeadachesNausea/VomitingDizziness/FaintingEars (incl. hearing aids)Eyes (incl. glasses)JawDental WorkBack PainFeetJointsBowelsBladderStomachLiverGallbladderIndigestion/HeartburnAsthmaSinusBlood PressureStrokeHeartEpilepsySkin RashesBruising/SwellingHerniasWeight ChangesHormonesSleepingEnergy LevelsAllergiesLungsNeck Pain

Do you smoke?
YesNo

Do you drink alcohol? If Yes, how much per week?
YesNo

Are you pregnant or trying to conceive?
YesNo

Please list any Accidents (Including childhood, sports injuries, serious falls, car accidents etc):

Please list any Surgery/Medical History/Major Illness/Medical Diagnosis (include how long ago or approximate age):

Are you having any other forms of therapy at the moment (please specify)?

Exercise (what type and how often)

Relaxation (what do you do to relax)

Disclaimer
Simply Natural Therapies does not proclaim to treat or cure clients in any manner, though, we will do our best to provide assistance to the best of our abilities at all times. Biodynamic Craniosacral Therapy can be used entirely on its own, however it is not meant as a substitute for medical, or psychological, diagnosis and treatment. Our practitioners do not diagnose conditions, nor do they perform medical treatment, prescribe substances, or interfere with the treatment of a licensed medical professional, unless they have received training in such a licensed professional practice that supports this. Biodynamic Craniosacral Therapy should not compete with medical doctors and their treatments. However it can be used together with any other form of medical, natural or alternative therapy in order to compliment it.

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