Welcome!

​If you're a first-time client, please fill out the form on this page before your first appointment. 
Upon receipt, I'll be in touch with you very shortly to set up an appointment time that's convenient for you.

​​​If you have questions prior to scheduling, please contact me. I'm happy to assist in any way!

    NEW CLIENT INTAKE FORM

    Please answer applicable questions, and skip those not relevant.

    Contact Information

    Appointment Logistics

    Client Information

    Treatment Goals

    Emergency Contact

    Connections

    Craniosacral Therapy Treatment Disclaimer & Consent

    I understand that Craniosacral therapy is a gentle, hands-on energy technique that works with the subtle rhythm of the cerebrospinal fluid in the body and is utilized for stress reduction and relaxation. I understand that Craniosacral therapy practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, or interfere with the treatment of a licensed medical professional. I understand that Craniosacral therapy does not take the place of medical care. It is recommended that I see a licensed physician or licensed healthcare professional for any physical or psychological concerns or conditions I may have. I understand that Craniosacral therapy can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long-term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

    Cancellation Policy

    A minimum advance notice of 24 hours for cancellations is required.
    Late cancellations and missed appointments carry a charge of $25.00 up to the full fee.

    Privacy Notice

    No information about any client will be discussed or shared with any third party without the written consent of the client or the parent/guardian if the client is under the age of 18.
    Thank you for taking the time to fill out this form. I look forward to working with you.