Health and History Questionnaire

In order for me to design a safe and effective program tailored to your interest, it is important that you complete the following Health History to the best of your ability. The information will be used for need determination, not diagnosis.

  • MM slash DD slash YYYY
  • Please describe your pertinent medical history, with dates whenever possible.
  • By submitting this form you certify that the above information is true and accurate to the best of your knowledge and you give permission to proceed with an Aston-Patterning® session(s).