I hereby apply for a standard series of processing in Rolfing (Structural Integration).
I fully understand the purpose of Rolfing is to balance and align the physical
body so that it is supported and maintained by gravity in three-dimensional
space. This is done through direct manipulation and education so that the greater
economy and freedom of body-movement are achieved.
I understand Rolfing is not involved with the treatment of disease of any kind, nor does it substitute for medical diagnosis or treatment when such attention is needed.
The Rolfer does not treat, prescribe or diagnose an illness, disease, or any other physical or mental disorder of the person. Nothing said or done by a Rolfer should be misconstrued to be such.
I understand it is necessary for the Rolfer to touch my body in order to assist me in establishing balance and alignment in the body.
I give Carolina Rolfing Associates my permission and consent to do all those things necessary in helping me establish balance and alignment, including, but not limited to touching my body. I give the Rolfer full privilege and license to work on my body in such a way as to restore and establish balance therein.
Furthermore, I understand that any relief of physical or emotional symptoms is coincidental in the organization of the total human being and is not the basic goal of Rolfing.
Date______________________________________ Applicant's Signature_________________________
Applicant's Printed Name____________________________________
Address__________________________________________________
City/State/Zip______________________________________________
Phone____________________________________________________
Witness__________________________________________________
® The word Rolfing is a Service mark of the The Rolf Institute
of Structural Integration.