First Name *

Last Name *

Date of birth *

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

How did you hear about Wandering Bear Wellness? *

What are you goals for receiving work from Wandering Bear Wellness? *

What have you tried in the past to alleviate your concerns? *

Why is working with Wandering Bear Wellness the right approach for you at this time? *

How long/how many sessions do you think this issue will take to resolve? *

How much water do you drink per day? *

What is the source of the water you drink? *

On avg. How many hours do you sleep per night? *

What movement practices do you have? *

If you going through the Rolfing 10-Series? Would you be interested in documenting your progress with before-and-after pictures?

Would you be open you other services to help you reach your goals? *

Client Agreement & Consent for Structural Integration at Wandering Bear Wellness

All client information is strictly confidential. Written consent is required before any information can be released.

Session Policies:

Please arrive on time. Due to the nature of Structural Integration and the need to use the full session time, arriving 15 minutes or more late may result in a canceled session and full charge.
A 24-hour cancellation notice is required. Missed sessions without proper notice will be charged the full session rate.
Each session includes a brief consultation to discuss your current state and the focus of that day's work.

About Structural Integration: Structural Integration (also known as Rolfing®) is a form of bodywork that aims to align and lengthen the body along its central vertical axis. This is achieved through:

Physical contact and manual therapy
Movement education
Body-centered awareness

The work focuses primarily on the fascia, the connective tissue that surrounds and supports muscles and other structures.

Important Disclaimers:

Wandering Bear Wellness does not treat or diagnose disease, nor does this work replace medical care from a licensed physician.
Any physical or emotional relief experienced during or after a session is coincidental to the realignment of the body, and is not the intended therapeutic goal.
Wandering Bear Wellness is not liable for any pre-existing medical or emotional conditions or issues that arise during sessions but are not directly related to the Structural Integration work.

Consent & Communication:

Touch is an essential part of Structural Integration. By signing this form, you give permission for your practitioner to touch and work with your body in a respectful and professional manner.
You may withdraw your consent or stop a session at any time. However, doing so does not exempt you from the cancellation policy.
Open communication is vital. Please inform your practitioner at any time during the session if you feel discomfort or pain.
You confirm that you’ve disclosed all relevant medical conditions and agree to update your practitioner with any changes in your health status.

By submitting this form, you acknowledge and agree to the policies and statements above.