Personal Information & Health History

Before we start our journey together, I really need to know who you are and your current condition.   So, please take the time to complete the required forms, entirely. 

I realize some of the forms are long, and in some cases, require duplicate information based on services, programs or package. 

But, it’s also very important so that I can gain a complete picture of who you are, your current physical condition, obstacles and challenges and most importantly your goals.   Thank you in advance for taking the time to carefully complete this form.