Pediatric Forms

 

For pediatric clients, please fill out our basic intake and history forms.

Included in this collection is a subjective survey that is based upon your assessment of the presence of any pains or problems or body signals that you are experiencing. These symptoms are categorized into the Six Health Zones.This part of the questionnaire will reflect what systems are under stress. Please rate each symptom according to how frequently it is experienced.

Upon completion, these will be submitted directly to our office. Trust and Healing take Time. During your first visits in the office, we aim to learn as much as we can about one another, building understanding and rapport.