Get Pediatric Craniosacral Therapy Intake Form

Completing the Pediatric Craniosacral Therapy Intake Form online is an important step in ensuring your child's personalized care. This guide will provide you with a clear and supportive approach to filling out each section of the form accurately and efficiently.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the intake form and open it in your preferred platform.
2. Enter the last name, first name, and middle initial of the patient accurately in the designated fields.
3. Fill in the birthdate, selecting the appropriate date from the calendar or typing it in the format requested.
4. Indicate the sex of the patient by selecting either M or F.
5. Complete the parent or guardian information, including their name, email address, and phone number.
6. Repeat the previous step for the second parent or guardian if applicable.
7. Provide the mailing address of the family, including city, state, and zip code.
8. List any life-threatening allergies that the patient has in the corresponding section.
9. Document who referred you to Dr. Emily Telfair, providing their name if applicable.
10. Detail the current health care team by listing the patient's pediatrician and any specialists along with their contact information.
11. In the current health concerns section, list the health issues in order of importance, including their onset and treatment.
12. Indicate whether the patient has ever received craniosacral therapy, and if so, note the date of the last treatment.
13. Describe the goals for the current visit, providing any specific objectives you hope to achieve.
14. List all current medications, supplements, or remedies that the patient is taking, ensuring to include all pertinent details.
15. Document any surgeries, accidents, injuries, or hospitalizations, along with relevant dates.
16. In the medical history section, mark any conditions that are currently present or have been experienced in the past.
17. Acknowledge understanding of craniosacral therapy and provide consent for the treatment by signing in the designated area.
18. Finalize the form by entering today’s date and saving your changes. You may choose to download, print, or share the completed document.

Complete your Pediatric Craniosacral Therapy Intake Form online today for a smoother healthcare experience.