Your case - soulbody

Your case

Good day! Please fill out this form before meeting with Soul&body Center specialists. This will help us better assist you and make more efficient use of our meeting time.

Take as much time as you need to fill out this form carefully and if you have any questions, we will definitely discuss them at the meeting. If some questions are unclear to you, skip them and ask at the meeting.

Thank you very much for your attention. Strong health, beauty and development!

    Email*

    First name*

    Last Name*

    Date of birth*

    Phone number (starting with +380)*

    Leave your complaints or request for a meeting here*

    List them, starting with the most relevant, moving to the less relevant.

    Indicate when exactly they started for the first time, when they intensify, when they weaken.

    Is there a connection with the daily rhythm (morning, night, evening, constantly or wave-like)

    A connection to your activities and stress?

    Is there anything that clearly works for you or something that you've tried that doesn't work.

    Have you had significant injuries, fractures, accidents, concussions (with or without loss of consciousness) in your lifetime?

    Specify which ones

    Were there any surgeries?
    Are there scars on the body?

    Aesthetic, laparoscopic and minimally invasive as well

    Are there any chronic diseases or conditions?

    If you have research files or photos, please send them to this email address:

    soulbody.adv@gmail.com

    Please include your last name in the title of the letter

    For women:

    • - do you have children?

    • - how was the pregnancy, pregnancy (threats, interruption, conservation, IVF, treatment)?

      • How was the birth:

    • - natural (initiated independently or stimulated, epidural anesthesia, puncture of the amniotic sac, oxytocin)

    • - caesarean section (scheduled or emergency)

    To all:

    • - what do you know about your birth?

    • - do you have older brothers and sisters?

    • - how was the pregnancy and childbirth?

    • - how was the first year of life?

      • If possible, ask the parents, please.

    A few more questions about the condition of your teeth:

      Are there or were:

    • - removal

    • - crowns

    • - implants

    • - braces

    Do you have piercings?

    Are you currently taking medication?

    (if so, specify which ones)

    Do you have a daily rhythm?

    • - at what time do you wake up and go to sleep?

    • - how well do you sleep?

    Do you have a diet?

    What are your eating habits and peculiarities?

    Do you have a rhythm of activity?

    What kind of activities and how often?

    How can I conveniently reach you?*

      Please specify which messenger would be convenient for you

    After receiving services, do I need to receive a signed Medical Services Rendered Act?

    How did you find out about Soul&Body?


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