First Name *
Last Name *
What is your chief complaint? Please describe the nature of your discomfort or symptoms:
On a scale from 1-10, how intense is your discomfort?
How long have you been dealing with this discomfort?
What other avenues of treatment have you pursued?
What degree of success have you had with your previous treatments?
When is the pain or discomfort the worst? Is it during a particular time of day or during a specific activity?
When did your symptoms first appear? Was it gradual or was there an event that triggered it?
What is your occupation?
Are there any activities you used to do but can no longer do?
Do you have any major diseases or disorders?
Other information you would like to add:
Body Mechanics Therapist specializing in clinical and technical soft tissue manipulation. Jason Ravel applies Biomechanics and nueromuscular techniques.
© Ravel Therapy - Therapist Redlands, CA 92373