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Vaginal Steam Intake Form

Step 1 of 6

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  • Date Format: MM slash DD slash YYYY
  • Contraindications

    There are times when it is not beneficial for a woman to steam. First, let's check and make sure that you don't have any contraindications.

    Check all that apply:

  • Characterized with a burning itch?
  • Burning of the fallopian tubes through laparoscopic surgery through the belly button,
  • (i.e. Nexplanon)
  • WARNING

    The above "Yes" replies indicate that V-Steaming is contraindicated. It is not safe and could result in negative side effects such as the onset of bleeding, an outbreak, a miscarriage or a birth control failure. Steaming should not be performed at this time. If a birth control contraindication, it is up to the client whether or not she would like to do the steam session with the possible pregnancy risk.

  • Sensitivities

    Some women are very responsive to steam and it can cause a physiological response. If you are in this category then it is okay to steam, however, your practitioner will adjust your steam session and herbs so that it perfectly suits you.

  • (If so, it should be removed prior to steam session)
  • Warning

    The above "yes" replies indicate sensitivity in which case a mild setup without a burner should be used. Under no circumstances should clients who have sensitivity use an advanced setup with a burner.

  • Herb Selection

    It is best to select herbs suitable to your constitution. Your practitioner will use the info from this intake form to select a suitable vaginal steam formula for you.

    Indicators for Cleansing Herbs

    Check all that apply:

  • Indicators for Mild Herbs

    Check all that apply:

  • Indicators for Disinfecting Herbs

    Check all that apply:

  • Indicators for Cooling and Moisturizing Herbs

    Check all that apply:

  • If the client has indicators for herbs in different categories always prioritize the mild herbs. If the mild is not indicated then proceed with the best choice for the situation.

  • Cloaking

    When steaming it is often commonplace to cloak. In certain customs, a nice breathable fabric cloak is used. This cloak is safe in all situations. In other traditions, a plastic cloak is used to increase sweating and circulation and to enhance the detoxification benefits of the steam session. In this instance, plastic cloaking is not suitable if the client has excess heat in the body.

    Let's check for excess heat.

  • Waiver

    Most of the side-effects reported while steaming are positive. Users have reported better sleep, decreased swelling in legs and feet, decreased abdominal bloating, slimmer waistline, increased libido, decrease in breast soreness, fewer headaches, fewer PMS symptoms, increased energy, lucid dreams, tingling feet, glowing skin, reduction in the incidence of hormonal acne and increased lubrication.

    However, some undesirable side effects might also occur. These include shortened menstrual cycles, the onset of bleeding, headaches, the sensation to urinate or an infection outbreak. In 99% of all cases using a mild steam session and mild herbs will prevent the above from happening so it's very important that you give honest answers in this intake form so that the practitioner can set up a steam session that will fit your needs.

    I understand that V-Steaming may have positive or negative side effects as a result of doing a vaginal steam session. I accept legal responsibility for my choice to do a vaginal steam session and waive the responsibility of the practitioner and the facility where the steam session in the place that the named side effects (or others) may occur.

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Clinic Hours

Monday - Friday: 10am - 7pm
Saturday: 9am - 7pm
Sunday: 9am - 7pm

By appointment only.
Call us to make an appointment between the above hours.

  +(780) 802-5955
 info@healthzinergy.com

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Daisy Sanjase
Daisy Sanjase Blackwood

Daisy is a firm believer and advocate of Naturopathic medicine, arising from her own experience of achieving wellness after being faced by health challenges after being diagnosed with a thyroid disorder. Inspired by this incident and due to her passionate desire to help other people achieve the best health they possibly could she became a Colon Hydrotherapist certified by The Canadian Association of Colon Therapists (CACT) Colon hydrotherapy is a therapeutic process that is essential for better digestion, clear skin, vibrant energy, improves the immune system, weight management, and overall health.

Daisy also specializes in women’s intimate rejuvenation; assisting women to reclaim hormonal balance and optimal vaginal and reproductive health through a holistic and herbal steam experience.

Daisy has a background in Sociology (York University) as well as a diploma in Assaulted Women and Children Advocate Counsellor (George Brown College). She worked in various capacities as Counsellor, Advocate and Support Worker for various organizations that worked with women, children and vulnerable/disadvantaged population, providing support and empowerment. She has also worked with individuals with Mental health, addictions and in those recoveries.

She founded Health Zinergy to continue to heal herself and others. She utilizes different healing modalities thus the term health synergy (“Health Zinergy”) to achieve optimum health. Daisy is a Microbiome enthusiast who enjoys researching the Gut-Brain connection and how it affects our lives: Brain health, digestive health, behavioral disorders etc. She loves traveling, meditation and continues to advance her education in health and wellness.