To complete the form:

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Click on the "FILL OUT FORM" link above.  You will be directed to an online PDF form that you can fill out and submit.  To fill out the form click "continue" on the bottom of the page that comes up, then:

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Page 1 – Check off any item that represents how you are feeling using the past week as your guide.

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Page 2 – List the top 3 things you would like to see shift/change in your life along with their presentation, duration, intensity, and duration.  See the example for how to do this.

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Page 3 – Fill out your information.

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Page 4 – Informed Consent - read and sign.

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Once you are done filling out the forms, click the blue circle that says "Click to Sign" in the black box at the bottom.

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Important! Check your email after you submit the form to verify your identity. (We won't get the form until after you verify it from your email.)

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The purpose of the Checklist and List of Shifts is to drill down and identify exactly what you are experiencing, what is bothersome, and what you would like to see change.  This helps us (and you) monitor your progress as we work with you during training.

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Please complete and submit the form at least 24hrs before your visit so we can review them prior to your session.  If you prefer, you can print and fill out the form and bring it with you, but this doesn't  give us as much prep time.

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Thank you!! 

Lisa & Rick