16.2b.p1-4 pcaci (page 1)
Pre-course Assessment & Client Information
What is your most severe health problem or symptom?
What was the deciding factor that led you to start our course?
Name of the person who referrred or recommended us to you:
BREATH POWER - Buteyko Training Services 16.2.B.P1
List age first diagnosed on left hand side and place an X
the appropriate box M=Mild, S=Severe, VS=Very Severe
Have you had your tonsils removed & when?
Have you had your appendix removed & when?
Do you wear glasses or contacts & when?
Have you had any other major operations (please list) ?
BronchiectasisCystic FibrosisEmphysemaCOAD or COPDFibrosing AlveolitisSleep Apnoea
Have you had any major car accidents (please list) ?
Multiple SclerosisAttention Deficit DisorderArthritisCancer
Date of most recent hospitalisation and reason?
Have you had any broken bones (please list)?
Heart ConditionAnginaHigh Blood PressureTinnitusGout
Do you have any known allergies to drugs?
Irritable Bowel SyndromeEndometriosisKidney DiseaseSchizophrenia
Others Consulted (eg Chiro, Physio, Naturopath etc):
InsomniaMigraine HeadachesParkinsons DiseaseOther
BREATH POWER - Buteyko Training Services 16.2.B.P2
Symptoms suffered prior to commencing program
Place an X
in the appropriate boxes for severity M=Mild, S=Severe, V=Very Severe & Frequency D=Daily, W=Weekly O=Occasionally
Sudden chilling of limbs & other parts
Heart pounds easilyLoss of feeling in the limbs
BREATH POWER - Buteyko Training Services 16.2.B.P3
# mins am noon pm Puffers/Turbohalers/Oral tablets
Maximum number of times per day used when reqd
I am aware that during this course I will be instructed in the Breath Power - Buteyko Technique of breathing reconditioning. It is then up tome to use these techniques in order to gain long term improvement. I fully recognise that breathing reconditioning requires much discipline and that if I, or my child/guardian, cease to use the technique that symptoms may return. I am aware that medication should bekept handy at all times in case of emergency. I accept full responsibility for my future use or non-use of these techniques and therefore fullresponsibility for any deterioration of health that may occur in the future.
I understand that the method taught to me or my child/ward is tailored to suit my condition/s and I agree not to teach the regimes to others.
I understand that the Breath Power - Buteyko Breathing Reconditioning Programme is a series of lectures and training in breathing recon-ditioning, and does not constitute medical treatment. Further more, I, the undersigned, agree to only modify prescribed preventative medication after consultation with a medical doctor.
The place of origin of this disclaimer agreement is the State of Western Australia, Australia and it shall be governed in accordance with thelaws of Western Australia. The courts of Western Australia shall be the forum for the resolution of any dispute arising hereunder.
If under 18 this form must be signed by a parent or guardian.
BREATH POWER - Buteyko Training Services 16.2.B.P4
Painkillers are the most widely used drugs in the treat-ment of livestock. Across India, Pakistan and Nepal, vultures were exposed to one such drug, diclofenac, while at carcasses of animals treated with the drug shortly before death. Diclofenac, which causes gout and renal failure, is highly toxic to Gyps vultures and has led to a precipitous tim jACkson decline of more than 99 per ce
Unione Europea e Mercati Esteri 300 modelli di gru allaconquista del mondo Autogru PM - oltre 300 modelli di gru - ha potrebbe fare arrossire i boss dell’indu- sviluppato il proprio business all’estero soprattutto tramite un capillare network di importatori, capaci di costante, da assicurarsi un posto al sole gestire una distribuzione effici