Questions for CranioSacral booking

CranioSacral
Initial Booking Questions

Filling in these questions will help you identify issues and provide me with an initial assessment.

Name

Date of Birth

Day

Month

Year

Address

Phone

Physical Health: Any illnesses, injuries or physical conditions including general health

Medication: are you taking any medication at the moment short or long term. Please also include any supplements you are taking.

Emotional Health: what is your overall sense of well-being at the moment?

Mental Health: are you anxious, angry or feeling numb? Do you have brain fog or an overactive monkey mind? Do you experience frequent negative thoughts?

Energy Levels: How well do you sleep? Do you often feel lethargic or apathetic? Do you experience feelings of high energy and then find it difficult to relax?

Please give me a brief history of any injuries, falls or traumas since your birth until adolescence.

Have you had any face or head injuries?

Have you had any dental work including root canal, implants orthodontics?

Please write anything else that you would like to share here.

CranioSacral Initial Booking Questions

Filling in these questions will help you identify issues and provide me with an initial assessment.

CranioSacral
Initial Booking Questions