top of page

Intake 

ALIGN OSTEOPATHY

INTAKE FORM

Birthday
Year
Month
Day
Have you been in a car accident?
Yes
No
Have you ever experienced a fall to your tailbone? buttocks?
Yes
No
Have you ever experienced a hard blow to your head or had a concussion
yes
no
Have you ever had spinal surgery?
Yes
No
Do you have any pins, plates or screws in your body?
Yes
No

Client Consent to Assessment/ Treatment

Manual osteopathy is widely recognized as one of the safest drug-free, non-invasive therapies available for a the treatment of neuromusculoskeletal and joint complaints.

Treatments may include manual therapies where the health practitioner places their hands on your body.


Many techniques will involve contact between your body and the practitioner’s body. Body and hand contact may include areas of your chest wall, pelvic floor, and pubic bones. If intraoral is required (work inside the mouth) disposable latex or vinyl gloves will be worn.


At times, the practitioner may ask you to remove some items of clothing in order to facilitate assessment/treatment. If you do not feel comfortable with any part of the treatment, please inform your practitioner immediately. The techniques can be discontinued or modified as per consent.

Date
Year
Month
Day

CONTACT

At Align Therapies, we are committed to providing you with exceptional care and service. If you need to get in touch with us, you can leave a message with our office, and we will get back to you as soon as possible. We understand the importance of clear communication and strive to make the process as easy as possible for our patients. Thank you for choosing Align Therapies for your healthcare needs.

bottom of page