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Client History Form

For all clients to complete once

Please complete this form prior to presenting for your first visit with us. The information in this Client History Form is critical to us being able to help you effectively. The reason it is so extensive is that you will not think of many things to tell us that could actually be quite important clues, or warning signs. Something as simple as a recent change to your sleeping pattern, or recently not wanting to eat at a particular meal time could be important, but many will fail to mention these things unless specifically asked. Other things can make certain techniques less applicable, or even dangerous, as in the case with pregnancy, or post trauma. Please be honest. We are not judging. Our job is to figure out how to effectively help you. This job can only be achieved with as complete a picture of what is happening with, and to you, as is humanly possible.

If you have any questions about this form, please let us know.

Important: If the form below fails to work with your browser or device, please click here to go directly to the form via Google Forms.