top of page

h o l d . s p a c e . healing

Bodywork & Craniosacral Therapy Intake

LMBT, AP: Catherine Warner

Birthday
Do you have any allergies to oils, lotion, or essential oils?
Are you currently under medical supervision?
If YES, have you been cleared for Massage & Bodywork Therapy?
Are you currently taking any medication that is a blood thinner, blood pressure reducer, beta blocker, painkiller, or anything that can cause reduced physical sensation?
Please list any condition listed below that currently applies to you:
FOR CRANIOSACRAL THERAPY, please check if you have any of the following

I, the Client whose name is typed above, understand & consent that I am receiving a Massage & Bodywork session with Craniosacral Therapy, or a full Craniosacral Therapy Session.


Massage & Bodywork Therapy are provided for the basic purpose of relaxation and relief of muscular tension.


Craniosacral Therapy (CST) is a gentle touch therapy used by palpating the bones of the "cranio" skull and "sacral" tailbone, and other bony landmarks of the skeleton. This non-invasive palpation creates slack in the dura mater and allows cerebrospinal fluid (CSF) to move more freely. When CSF moves freely, the mind-body can better regulate the nervous system, promoting its natural ability to self-heal. Other benefits include an unwinding of neurological patterns & better ability to self-regulate, more efficient responses to internal & external worlds, reduced physical pain, restoration of musculoskeletal range of motion, and recovery of an embodied sense of self.


I understand these modalities should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of. I understand that massage therapists & bodyworkers are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.


I understand these modalities should not be performed under certain medical conditions, so I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the Practitioner updated to any changes in my medical profile & understand there shall be no liability on the Practitioner's part should I fail to do so.


If I experience any pain or discomfort during any of my sessions, I will immediately inform the Practitioner so that it may be adjusted to my level of comfort.

Date
bottom of page