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Client Assessment Form

Complete your full assessment & body analysis before your visit.

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Natural Healing Nirvana — Wellness Centre

"The place of rejuvenating mind and spirit"

Account Details
Personal Details
Medical History & Contra-Indications
Client Assessment
AreaGoodSatisfactoryPoor
Thigh
Abdomen
Buttocks
Home Advice & Future Recommendations
Posture / Body Analysis
Posterior View
Head & Neck — Head tilt
Shoulders — Uneven shoulder height / scapulae
Trunk — Scoliosis
Pelvis & Hip — Lateral Pelvic Tilt (Uneven hips)
Knee — Genu Varum / Genu Valgum
Ankle & Foot — Pes Planus / Pes Cavus
Lateral View
Head & Neck — Forward head / Protruding chin
Shoulder — Forward Shoulder
Thoracic — Kyphosis
Lumbar — Lordosis / Sway Back / Flat Back
Pelvis & Hip — Anterior / Posterior Pelvic Tilt
Knee — Genu recurvatum
Anterior View
Head & Neck — Lateral tilt / Mandibular asymmetry
Shoulder — Dropped / elevated, uneven clavicles / ribs
Ankle & Foot — Hallux valgus / Hammer toes
Lumbar — Lordosis / Sway Back / Flat Back
Pelvis & Hip — Anterior / Posterior Pelvic Tilt
Knee — Genu recurvatum

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