Fascial Maneuvers—Getting to Know You

I created this form below so I can get to know you a little bit more. Also, we can track your individual progress as it relates to your issues.  Please note, there are some mandatory fields regarding to Consent, Disclaimer and Disclosure. I will never share your information, this is private and between you and me.

Name
Email
Gender at Birth
Are you in your ...
Are you currently experiencing pain?
Do you have any balance issues in standing?
Vertigo, any other type of balance issues
Do you have any significant medical challenge I should be aware of that would impact your being able to move, bend, twist, stand, sit and squat independently?
Can you currently move into a full squat position and stand up from it independently without losing your balance?
Don't stress about this question. If you can't squat or don't know if you can or haven't ever done it, we modify that movement, I am obtaining baseline information here.
Is there anything else you would like to share with me?

Listed below in yes/no format are consent to participate with me in fascial maneuvers. As well as my disclosures and disclaimers.

I request that Rosemary Slade guide me in Fascial Maneuvers and set up a program for me in the areas of lifestyle changes for the purpose of reducing stress and enhancing my health.
I understand that Rosemary Slade has a degree in occupational therapy and has a large body of knowledge about human health drawing on her 25+ years of direct experience working with clients in movement, health, and wellness. I understand Rosemary Slade is a Volunteer Coach in the Fascial Maneuvers Program Outlined in Human Garage, and as such, is not working in the capacity as a registered occupational therapist, nor am I one of her occupational therapy patients during our Fascial Maneuvers classes.
I understand that natural health care is not intended as diagnosis, prescription, treatment or cure for any disease, mental or physical, and is not a substitute for regular medical care.
I understand that any recommendations are for the reduction of stress and are not intended as a treatment or prescription for any disease, or as a substitute for regular medical care.
As a sovereign being, I am capable of choosing those procedures that I consider to be useful to me and that have the potential to improve my life. I understand that no health care screenings or questionnaires are foolproof and further, I accept the risks and take full self-responsibility for that which I consent to.
I understand that Rosemary Slade may make recommendations about lifestyle changes, and that I can choose to participate with any or all of these suggestions.
I enter this Relationship with Rosemary Slade regarding Fascial Maneuvers of and with my own free will, without any pressure or promise.
As a soverign being, I accept full responsibility for myself. I maintain my right to my personal freedom of choice and decision making regarding any health improvement practices that I choose to receive. I also understand that I can choose not to participate with Fascial Maneuvers and Rosemary Slade at any time.
I understand that with any activity regarding moving my body, I am responsible for my personal safety at all times. I further understand that I can and will choose to participate at the level I am most comfortable participating in.
By clicking on the YES button, and/or entering my name below, I accept and agree to the terms above and want Rosemary Slade to coach me in Fascial Maneuvers.

What is 7+4?