An Osteopathic Approach

12918 County Road 15, Merrickville, ON K0G 1N0

613-269-2069 /

Dear Client,

Welcome to An Osteopathic Approach here at the “clinic” we look at things differently than other therapists. This is not a new treatment-rather a very old and classical approach to healing the body. We will look at your body from a “how do I get this body to heal itself” point of view. Believe it or not our bodies have been designed to be able to heal themselves…we cut our finger, we clean the cut, stick a band aid on it and with in a few days presto no more cut!!! Our bodies were meant to heal this way.

Somewhere along the line we have gone astray. With the increased stress, increased work-loads, families, job loss and changes etc our bodies are getting bogged down. We are able to keep going but at some point our bodies give up. Our bodies are like layers of an onion every emotional incident, high stress situation, injury etc gets trapped in the layers and the body is not able to react as quickly. We begin to get sick, a cold here, sinus infection there, it all adds up.

When our bodies are functioning at their prime illness and injuries are few and far between.

The Osteopathic Approach assesses the body from an individual joint point of view as well as group spinal point of view. We look at the pelvis as if it were the foundation for your “house” and as we all know that if the foundation is unbalanced so are the structures above and below it.

With all the individual joints and group spinal mechanics comes along with nerves. Each nerve has a bone, joint, and organ that correspond to it. If the bone is not moving in the proper direction it throws off the whole complex!

Osteopathy is a gentle yet thorough approach to ensure each of the joints and nerves are functioning properly. Through a series of movements, stretches, resistance, and assessment we are able to encourage the body to work properly.

When we are hurt we would like the pain to go away ASAP. Osteopathy works well in acute and chronic conditions. It is effective in treating many conditions such as stress, joint pain, headaches, neck and shoulder pain, sinusitis, whiplash, low back pain, sciatica, scoliosis, breathing problems, rib dysfunctions, muscle spasms, athletic injuries, carpal tunnel, tennis and golfers elbow, tendonitis, arthritis, sprains and strains, to name only a few.

Osteopathy works with the nervous system. It will also help to support people with Attention Deficit disorder, chronic fatigue syndrome, fibromyalgia, chronic infections such as otitis media and sinusitis, gastrointestinal disturbances such as irritable bowel and reflux, as well as tinnitis and vertigo.

Office Policies

  • You are able to get a hold of me through e mail: , or by phone at 613-269-2069 (keeping in mind that this is also my home number).
  • Please arrive 5 minutes prior to your appointment. Please come in quietly as someone else will be finishing their treatment.
  • Please advised of any changes in medication, or health related conditions.
  • There is a 24 hour cancellation policy. Missed appointments will be billed in full. Arriving later than 15 minutes of a scheduled appointment will result in no treatment and you will be billed in full. There are many people needing appointments if you are aware that you cannot keep your scheduled time-please cancel as soon as possible. Please leave a message or send a note to and I will return your call as soon as possible to reschedule.
  • You are able to pay with cash or cheque at the end of each treatment. Receipts will be given for each treatment and on the receipt are my association number, address, qualification number and phone number, all of which are required by the insurance company. Osteopathic treatments are covered by most extended health care companies.
  • If you are coming here with injuries related to a motor vehicle accident, I am not able to deal with the insurance companies. You will need to pay for the treatments and in turn bill your insurance company.
  • Information will not be released to ANYONE without prior written consent.

Treatment Costs

Initial treatment and assessment$100.00

45 minute treatment $75.00

30 minute treatment$60.00

Receipts will be given at the end of each treatment.

24 hour cancellation policy

I,______understand that there is a 24 hour cancellation policy in effect. This also includes if I am more than 15 minutes late for my appointment. I will be billed in full.

Signature.

CHERYL CHRISTIAN

12918 County Road 15, MERRICKVILLE, ON

613-269-2069 /

CLIENT HEALTH HISTORY FORM

CONFIDENTIAL

Please complete this questionnaire (both sides). All the information on this form is confidential and will be used for no other purpose than my clinical studies.

Name: ______Phone: ______Alt #______

Address: ______City: ______P.C.______

Date of birth______*E MAIL: ______

Due to the nature of this business e-mail is the best way to communicate and make appointments. Though all phone calls are returned as soon as possible.

Occupation: ______Reason for Massage: ______

Family Doctor: ______Address: ______

Doctor’s Phone: ______

Extended Health Care Coverage? YES / NO

Where did you first hear about this clinic? ______

Name friend/doctor/N.P./Advertisement

Please note there is a 24-hour cancellation policy…. full treatment fees will be charged

Health History: Please check  the symptoms that are present and X symptoms you have

had in the past.

Head:RespiratoryCardiovascular

Headachechronic coughblood pressure

type______shortness of breath high______

dizzinessasthma controlled? Y N

earaches last attack______low______fainting?

sinus issuessmokingpoor circulation

where______how many______heart disease

neck paincatching of breath what______where______breathing in when______

when______breathing out familial______

vision/hearing loss [] high/low cholesterol

Muscle and jointsSkinDigestive

arthritis type____  sensitive skinpoor appetite

family history of arthritisrashes/eruptionsnausea

stiffness/swellingacnedue too______

discomfort/paincold soresconstipation

decreased motionbruise easily consistent/occasional

which joint______varicose veinsdifficult digestion

[] osteoporosis? phlebitis gas/belching

eczema/psoriasis abdominal pain after eating Y N

diabetescancer: type______seizuresinfectious diseases______

OrgansWomen

livermenstruationpregnant

gall bladder painful children#____

removal Y Nheavymenopause

when______light

attacks Y Nirregular how?

kidneysnormal

stones______

bladder

weakness Y N 

ovaries removal Y N

uterus removal Y N

Medical conditions: (all relevant)(pins,wires,etc.)Cancers.

______

______

AllergiesCurrent Medication (list all including

______Supplements and condition being treated.)

______

______

______

______

SurgeriesAccidents (MVA/Otherwise)

Date:Type: ______Date:______Injury: (area of body)

______

______

______

______

______

previous massage yes noOther health care (present or pastX)

previous osteopathic tx yes noChiropractor

previous cranial tx yes nophysiotherapy

good sleeping patterns yes noacupuncture

regular eating habits yes nopsychotherapy

regular exercise yes noother

Signature: ______

Date: ______

Date updated:______