CLICK HERE: New Client Intake Forms

What brings you to CFT?

Body tension/Discomfort

Digestive issues

Nursing/Feeding concerns/picky eater

Oral Ties

Oral Function

Orthodontics/Dental work

Trauma/Injury

Anxiety/Depression

Poor sleep

Frequent illness

Frequent ear infections

Surgery

What other therapies if any have you been working with so far?

Traumas/Injuries

Type of delivery and possible complications?

What type of feeding ar you doing?

Breastfeeding

Bottle feeding with breast milk

Bottle feeding with formula

Baby has started solids

Pacifier or thumb sucking?

Yes

No

Infants/Child clients ONLY: Please select any current issues

Intake Form