Telehealth Intake | Zenbrio House

How To Prepare For Your Session

✔️ Complete the pre-assessment form (below). This allows us to compare before and after, and note any positive improvements.

✔️ Be well hydrated – it’s best if you have a glass of water before we start. Yes, bathroom breaks during our session are fine!

✔️ Setup your phone or computer in a location where I can see you and you can move around a little bit. We will be doing interactive bodywork where I will be walking you through various movements.

✔️ Think about what you would like out of your session. We can do a generic tune-up session to help you feel better overall, or we can balance for something specific. These questions can help narrow it down:

- - What can be better?
  - How do you want to feel, that you are not feeling right now?
  - Is there something challenging, a problem, or a goal you want to achieve?
  - What is causing you stress, and how would you like to respond differently?

Name *

First

Last

Email *

How Did You Hear About Me *

Please Rate Your Current Stress Level (10=Extremely High, 1=No Stress):

Please Rate Your Energy Levels (10=Extremely High, 1=Extremely Low)

Please Rate Your Mood (10=Very Happy/Positive, 1=Very Low/Negative)

Are There Any Areas You Are Experiencing Pain, Tension, Discomfort or Reduced Range of Motion? (Please describe)

Are There Any Goals or Areas of Health Improvement You Desire, or Patterns You'd Like to Break?

Is There Anything Else You'd Like Me to Know About Before We Start?

What Is Your Priority For Today's Session? *

I understand that this telehealth session should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that the provider is not qualified to 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. *

Name