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Getting Started
Healing for Children

Getting Started!

To help me understand the needs of your child please take some time to complete the following information.

  1. Please use the form below to provide the information you would like me to have in assessing your child. Simply answer the questions below, fill in the Verifier box and click        Submit. You will then be redirected to our product catalog to complete secure payment for the first session using VISA or MASTERCARD.  Take as much space as you need to accurately represent your child and his/ her needs.

  2. In addition, in a separate email, please send me a photo or two of your child, with one being a close up of the face with specific attention to the eyes. It is OK to email these as an attachment if you are comfortable with that technology. If you need to mail it, please send it to:

Deb Schnitta
5647 Bryant Street
Pittsburgh, PA 15206

*Items 1 & 2 must be received before treatment begins.

If you are unable to submit the form after answering all of the questions and filling in the image validation box properly, this may be due to your computer settings (using an updated version of Mozilla or Internet Explorer as your web browser may solve this problem).

Please take the time to answer all of the following questions. Once finished, please click the Submit button. You will then be redirected to complete secure payment for the session using VISA or MASTERCARD. Thank you.

Cellular Healing for Children

1. Date

Date

2. Child's name and age, including any nicknames.

3. Child's Date of Birth

4. Parent's or Parents' Name(s)

5. Your E-mail Address

6. Phone Number with Area Code and Time Zone

7. Other family members (please include age of siblings)

8. What time is the usual bedtime (EST, USA please)?

9. Age at time of symptoms or injury

(If at birth, please include any relevant information about the pregnancy that you recall.)

10. Please tell me what happened:


11. What treatment approaches have you explored so far?

What have been the effects you have noticed? Please include both traditional and alternative medicine models. If possible, please include the approximate length of time for each modality as well as the order in which you did them if possible.

12. What are your child’s current health challenges?

Please take a moment to view your child from head to toe to make sure you include all areas of concern.

13. Please describe your child’s eating:

(types of foods consumed, special needs for meals, supplements (list reason for these if you know them)). Is this an area of concern?

14. Please describe your child’s typical sleeping pattern:

For example, does he or she fall asleep quickly only to awaken several hours later? How many hours per night does he/she sleep?

15. What are the current challenges for your child?

(in order of priority for you and your family)

16. What are your goals for your child?

(Both short and long-term)

17. Where does your child go to school?

Please describe the class, size etc., and the types of activities that are done. Are there any special areas of concern here for you and your child (difficulty with attention etc.)?

18. Please describe a typical day in the life of your child:

Please begin with waking and end with sleep. Next to each activity, please list the approximate amount of time and describe the activity a bit. An example might be: John likes to watch TV, he prefers the same shows each evening. He also likes to use computer programs and is able to match sounds and objects using a mouse. He gets tired after 20 minutes.

19. Is there anything else you would like me to know about your child?


20. Please remember to fill in the Image Validation box and click Submit.

If you are unable to submit the form after answering all of the questions and filling in the image validation box properly, this may be due to your computer settings (using an updated version of Mozilla or Internet Explorer as your web browser may solve this problem).

If unable to submit, you may print the page and fax it to 412.361.2300. Or, if you feel comfortable, save this information as a word document and email the document to Deb as an attachment. Please include Special Kids Form in the subject heading. Thank you. (email: vanati@vanati.com)

21. Please fill in the image validation box below and click Submit.

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