Bowen Therapy Intake Form
Thank you for you interest in the Bowen Technique. Please fill out the following intake questions 2-3 days prior to your initial appointment. To read more about the conditions that Bowen can address, visit:
Name (first, last)
Please provide the best number to use for scheduling purposes
Please record dates and details. Please make special care to note any breast/pec implants or reconstructive jaw surgery, both of which are contraindicated with certain Bowen Procedures.
Primary Health Goals
In what area(s) do you want to see the most improvement? What signs and symptoms would you most like to resolve? What does your healthiest self look like? Please be as specific as possible.
Prior Treatment for Presenting Conditions
Please note that, because of the subtlety of Bowenwork and the body's continuing response to it, other forms of MANIPULATIVE THERAPY performed up to four days before, or five days after, a Bowen session may interfere with its effectiveness.
Cranial Sacral Therapy
Regimen (diet, exercise plan, etc)
None of the Above
Other Relevant Comments:
I request and consent to Bowen treatment with Carol-Ann Galego. I understand that no promise or guarantee of specific results can be made. I understand that Bowen treatment should not be considered as a replacement for treatment by a Medical Doctor.
I have read and understood the above consent for myself and/or my child.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service