Severe difficulty breathing

Yes

Severe chest pain

Yes

Confusion or feeling unsure of where you are

Yes

Recent loss of consciousness

Yes

Fever (feeling hot to the touch, a temperature of 37.8 degrees Celsius or higher)

Chills

Cough that's new or worsening (continuous, more than usual)

Barking cough, making a whistling noise when breathing(croup)

Sore throat

Difficulty swallowing

Runny nose (not related to seasonal allergies or other known causes or conditions)

Stuffy or congested nose(not related to seasonal allergies or other known causes or conditions)

Lost sense of taste or smell

Pink eye (conjunctivitis)

Headache that’s unusual or long lasting

Digestive issues (nausea/vomiting, diarrhea, stomach pain)

Muscle aches

Extreme tiredness that is unusual (fatigue, lack of energy)

Falling down often

For young children and infants: sluggishness or lack of appetite

None of the above

I Verify

Initials:*

I knowingly and willingly consent to receive treatment during the COVID-19 pandemic.

Consent

Patient Name*

Email*

Date of Signature

Élan Osteopathic Clinic is privileged to provide trusted Osteopathic services to the people of Regina, White City, Balgonie, Edenwold, Pense, Pilot Butte, Grand Coullee, Lumsden, Craven, Southern Saskatchewan and beyond.

Live Telehealth Services

For Back, Joint and Muscle Pain

**Barbara Schultze**
Osteopathic Manual Practitioner
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Education

2012 Osteopathic Thesis: “The Effect of Global Osteopathic Treatment on Children Aged 60-156 months with Academic and Behavioural Difficulties” - Organization (location)
2007 Graduate in Osteopathy – Canadian College of Osteopathy (Toronto)
1999 Graduate in Remedial Massage Therapy - Western College (Regina)
???? Undergraduate Major – University (location)

Credentials

Diploma in Manual Osteopathic Practice (D.O.M.P)
Diploma in the Science of Osteopathy (D.Sc.O)
Remedial Massage Therapist (RMT)

Volunteering

Therapist: Police-Fire Games, Manitoba-Saskatchewan Swim meets, Echo Valley Triathlon, Women’s Volleyball Network, and Open Door Society (Regina)

Affiliations

Canadian Federation of Osteopaths (CFO), Board of Directors
Canadian Standard’s For Osteopathic Education Committee, Member
Saskatchewan Association of Osteopaths/Osteopathic Manual Practitioners, President
Ontario Association of Osteopathic Manual Practitioners, Affiliate Member
Massage Therapist Association of Saskatchewan, Member

Certifications

Dynamic Neuromuscular Stabilization (DNS) – Enrolled Prague School of Rehabilitation
Certified HANDLE Screener/ HANDLE Practitioner Intern – HANDLE® Institute (Seattle, WA)
Ages 5 & older: General Learning Disabilities, Attention Deficit/Hyperactivity Disorder (ADD/ADHD), Dyslexia, Perplexing Behaviors

If you’re experiencing pain, we have some GREAT NEWS!

We can help you with a NEW ONLINE PLATFORM that we are using. We can now connect virtually and help you live more comfortably.

If you are unsure about coverage, please check with your individual extended health plan.

Thank you for your support!

I verify that I have NOT been identified as a contact of someone who has tested positive for novel coronavirus or been asked to self-isolate by Saskatchewan Public Health.

At of the time of my appointment I do not have any of the following symptoms:

Have you had any of the following symptoms in the last 14 days?

I verify the information I have provided on this form is truthful and accurate.

I knowingly and willingly consent to receive treatment during the COVID-19 pandemic.

Phone

Fax

Address

Clinic Hours

Education

Credentials

Volunteering

Affiliations

Certifications