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Documents & Forms

The following documents and forms are used in this office to allow us to better assist you in meeting your needs.  These files can be best viewed using Adobe Reader; which can be obtained free at For your convenience you may complete these forms online, print out and bring to your appointment. Completing the Initial Intake Form before your first visit will save some time, as well. 


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.


Initial 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. 

Low Level Laser Consent Form- This form is used to authorize the clinician to use the Low Level Laser as an adjunctive treatment modality in your care. Low level laser therapy has been used for years in rehabilitation to promote healing while reducing pain. Treatments are applied to specific body points along various acupressure meridians; these points are mostly on the ears, face, hands and arms. The low level laser, as it is used here, works much like acupressure with the added benefit of enhanced stimulation of the identified points while helping to reestablish and unblock the flow of negative energy within the body.

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 diagnosis. 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 & Emotion Journal- 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" responses 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.

Better Breathing Exercise- This is the breathing exercise that was (or will be) presented during your session. Breathing is essential for life. When we aren't breathing well or completely (filling the lungs with life giving oxygen) we will not be able to focus our attention as well as we should. Remember, this is just but one tool that will help you in the quest to achieve your goals; use it every day and during times of increased stress to regain control and focus.