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Name

Address

Date of Birth

Occupation

Sport

Diagnosis

ASSESSMENT CHART FOR FASCIAL MANIPULATION©

SI-PA

PA-MO

PA CONC

PA-MO

PA PREV

OPER./FRACTURES/VISCERAL

Paraesthesia : CP

DI

PE

Posture:

HYPOTHESIS

Planes

Segments

MOVEMENT VERIFICATION

Seg

Sagittal Plane

Frontal Plane

Horizontal Plane

Diag

PALPATORY VERIFICATION

Seg Sagittal

Frontal

Horizontal

CF

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