Health questionary

Health questionnary

Determining the right body mind therapy for you.

This health questionary is an intake form allowing us to create the individualized therapy treatment plan, based on your symptoms and needs. 

Please,  complete this form before your first session.

  • The informations shared here are strictly confidential and bound by professional secrecy, and stored under protected access.
  • It is used to determine whether there are any specific contraindications to working together.
    It also enables us to draw up a therapeutic plan and choose the most appropriate therapies.
  • It helps to orientate the session to best address your reason of consultation.

Recurring pains, loss of a relative, major event or trauma, sensitive subject, recent fracture or body pain

Thanks for filling the form, we will get back to you soon.

*Any informations share here are confidential and will stay between you and your body mind therapist.

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