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Comprehensive Life & Health Profile

Congratulations on taking your next step on your journey towards vibrant health!

Please complete this general health history, as it will provide us as your doctors’ with important information to better understand your history, your present and longer term needs, and any compromise to your health, wellness, and overall quality of life that you may be experiencing now, or may have experienced in the past.

If you have not already done so, please take a moment to read the page on our Living Inline Balancing sessions as well as our Coaching Programs so that you are familiar with how you will benefit from this care.

Our Purpose: A Statement of Clinical Objectives

Our purpose in sharing this statement of clinical objectives is to clearly define our approach to Chiropractic, healing and those we serve in this office. We wish to clearly communicate our responsibilities in this exciting relationship.

The following concepts are central to the way in which we practice Chiropractic. We are pleased to share these ideas with you so our purpose can be in alignment from the very beginning.

There is intelligence within each individual that not only keeps that person alive, but also coordinates, repairs, renews and heals every cell of the body.

The nervous system is the main distribution center and coordinating system for this innate intelligence.

Proper coordination, repair, movement, healing and genetic potential cannot be fully expressed when this life power and intelligence is blocked or redirected.

The purpose of chiropractic adjustments given in this office is to correct vertebral subluxations, allowing a greater communication of this life power and coordinating intelligence thus promoting better health.

Everyone, in spite of specific symptoms or ailments, can benefit from a more flexible and subluxation-free spine and nervous system.

Symptoms are not necessarily a sign of illness, they can occur to alert the individual of the need for change.

Specific location of symptoms does not correlate to specific subluxations needing to be adjusted. Severity of symptoms does not correlate to severity of subluxations. The reduction of symptoms is not an effective indicator of improved health.

An individual may have symptoms and not need an adjustment on a particular visit. An individual may have no symptoms and may require extensive adjustments on a particular visit. A person’s symptoms are not necessarily in direct relationships to his or her prognosis.

We do not treat specific symptoms, conditions or aliments, other than vertebral subluxations. We do not imply that any particular adjustment or series of adjustments will have a direct effect on any symptoms or condition a person may be presenting. Research studies show thousands of patients receiving chiropractic adjustments report improved physical and emotional health and well-being.

We encourage any individual having concerns about symptoms or ailments to consult with a disease or symptom care specialist.

By their very intent, various treatments may interfere with the functioning of the nervous system. This may include drugs such as pain relievers, muscle relaxers, anti-inflammatory compounds and mood altering medication. This can often prolong the time required for spinal correction.

Medication levels for an inflexible body-mind stuck in sickness are not necessarily the same as for a body becoming well.

We will not venture into the practice of medicine by advising about the need for reduction of medications. We suggest you speak with your physician to determine the objective and goal to be obtained by receiving a particular medical treatment. Determine if this is consistent with your desire for wellness at this point in time. Your physician may guide you in changing any medication or treatments you are presently utilizing to accommodate for our changing body-mind.

Consistent with the above concepts, we locate and adjust vertebral subluxations using the techniques we believe to be the most honoring and effective.

Sincerely,

Dr. Jason M. Kolber, Dr. Elissa Katz & Dr. Stephanie

 

 

Please use the < TAB > key to advance to each entry form and the < ENTER > key when complete, or click the SUBMIT BUTTON at the bottom of the form. Thanks!

 

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PART 1:

Your Involvement in your Health, any Health Concerns that you may have, and how they may affect your life:
10a. If applicable, please grade the level to which the above health concern(s) has on your overall quality of life and health. Please use the following scale of 1-4; 1 being only a mild affect, and 4 having a significant effect:





PART 2:

Health / Trauma / Medical / Healing History:

14. Have you had any experience with the following health, treatment or healing modalities? (Please FILL IN all that apply and describe why you went and the results you experienced):

PART 3:

The Stress Survey
Please rate each category from one to five, one being the lowest and five the highest. Also, please check all experiences that may apply.

























8. When communicating to you about how your health is changing, how your spine is changing, how your nervous system is changing, How would you best like for us to communicate with you?