Alexander Technique
Client Intake Form

The purpose of this form is get an overview of your relevant medical history, as well as any accidents that may have contributed to your current postural condition. All information is kept strictly confidential.


Please print this form, fill it out,

then scan and email it HERE

or mail the form to:

The Center For Applied Posture

2 Keeler Lane, North Salem NY 10560

Client Intake Form