Rejuvenation Retreats
Trinity River Retreat Aug 2025
Tulum Retreat Feb 2026
Forest Rejuvenation Retreat Prague May 2024
Classes & Sessions
Access Bars Trainings with Brooke 2025
Session Details
Spinal Flow Intake Form
One on One
Birth & Postpartum Doula
Bee Well Ayurveda
Tips for Spring
Tips for Summer
Tips for Fall
Tips for Winter
About Brooke
Contact Us
Rejuvenation Retreats
Trinity River Retreat Aug 2025
Tulum Retreat Feb 2026
Forest Rejuvenation Retreat Prague May 2024
Classes & Sessions
Access Bars Trainings with Brooke 2025
Session Details
Spinal Flow Intake Form
One on One
Birth & Postpartum Doula
Bee Well Ayurveda
Tips for Spring
Tips for Summer
Tips for Fall
Tips for Winter
About Brooke
Contact Us
Spinal Flow Intake Form
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Spinal Flow Intake Form
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Name
*
First
Last
Phone
Email
*
Please mark any of the symptoms below that you experience.
Pause Gateway Upper Cervical
headaches or migraines
colds, flus, ear-aches, tinnitis
sinus sensitivities
difficulty sleeping
Passion Lower Cervical
sore throats, swollen glands
neck, shoulder, arm pain
thyroid imbalance
food sensitivities
tired after eating
Center Thorassic
blood pressure imbalance
heart burn, gas, burping, indigestion
asthma, breathing difficulties
kidney or bladder concerns
Power Lumbar
back pain
disc problems
digestive imbalances
constipation & or diarhhea
reproductive or hormonal imbalance
menstural pain
10? life hospitalization
Foundation Sacrum
lower back pain
hip pain & or sciatica
groin pain
knee pain
Base Phychology
nuerological imbalance
stress, anxiety or overwhelm
irritable, anger, criticalness
lethargy, sadness, depression
Other
Current physical pain or injuries
Past injuries, surgeries or hospitalization
Current stressors in your life
Past stress or trauma
What is your stress level on a scale of 1 to 10?
Selected Value:
0
How happy or you on a scale of 1 to 10?
Selected Value:
0
Current eating patterns: are you happy with your diet/ nourishment?
Current physical activity: type & frequency
What are you looking to get out of these sessions?
*
Thank you for filling out this form. Is there anything else you would like me to know?
Submit
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