Summary
Overview
Work History
Education
Skills
Disclaimer
Client Intake Sheet – Colon Hydrotherapy
Please circle all that apply
Daily Habits
Accomplishments
Languages
Timeline
Generic

Alex Tomas

Cookeville

Summary

Offering a solid foundation in English language studies and a passion for helping others improve their language skills. Delivers a strong understanding of grammar and composition principles and can quickly adapt teaching methods to individual student needs. Ready to use and develop language proficiency.

Personable and positive communicator with strong grasp of English language fundamentals. Well-versed in grammar and composition, with capability in crafting engaging lesson plans. Committed to fostering academic growth and helping students achieve mastery in English.

Overview

1
1
year of professional experience

Work History

English Tutor

Home Instead
08.2024 - 05.2025
  • Enhanced students'' reading and writing skills by implementing interactive and engaging lesson plans.
  • Strengthened students'' understanding of grammar rules by providing targeted instruction during individual or group sessions.
  • Fostered a positive learning environment by establishing clear expectations and offering consistent support to students.
  • Established rapport with students, fostering open communication and creating a supportive learning atmosphere.

Education

Medical Technology

Cookeville Highschool
Cookeville, TN
05-2026

Skills

  • Strong vocabulary skills
  • Bilingual in Spanish
  • Conflict resolution techniques
  • Motivating students
  • Organizational and time management skills
  • Error correction expertise

Disclaimer

I understand, have read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications for therapies/treatments received. I am fully aware that it is my responsibility to inform the therapist/representative of Cleanse Wellness Spa of my current medical or health conditions and to update this history. The therapies I receive here are voluntary and I release Cleanse Wellness Spa and its employees from liability and assume full responsibility thereof. I, _____________ the undersigned understand and agree to the above procedure of self-insertion. I understand that the Therapist will be present to supervise and instruct me.

Client Intake Sheet – Colon Hydrotherapy

  • Date: ________________________
  • Name: ______________________________
  • Address: ________________________________________________________________
  • City:________________________ State:____________ Zip Code: _____________
  • Phone:(HM): __________________(CELL):____________________ (WK): ______________
  • Occupation:________________________ Email: _____________________________
  • DOB: ______________ Age:________ Weight:_________ Height: ______________
  • Marital Status: __________ Sex: (M) _____ (F) _____
  • Medications: ________________________________________________________________
  • Supplements: ________________________________________________________________
  • Allergies: ________________________________________________________________
  • Bowel Movements: (DAY): __________ (WEEK): _____________
  • Name/Contact of Physician: ________________________________________________
  • Source of Referral (how did you hear about us): _____________________________
  • Recent Vaccine: __________________ Which One: ______________ Date:__________
  • Have you ever received a Colonoscopy? ______ Date: ______
  • Result: ________________________
  • Have you ever received a colonic? _____ Date: _______ Result: ______________
  • What would you like to achieve with colon hydrotherapy? ________________________________________________________________
  • Please circle all that apply
  • Severe Cardiac Disease (uncontrolled hypertension or congestive heart failure)
  • Aneurysm
  • Severe Anemia
  • GI Hemorrhage/Perforation
  • Severe Hemorrhoids
  • Recent Colon Surgery
  • Crohn’s Disease
  • Cirrhosis
  • Fissures/Fistulas
  • Pregnancy
  • Abdominal Hernia
  • Renal Insufficiency
  • Ulcerative Colitis
  • Subject to Frequent Seizures
  • Pacemaker or Electronic pumps of any kind

Please circle all that apply

  • GENERAL RESPIRATORY
  • Allergies
  • Shortness of breath
  • Chronic cough
  • Vomiting Blood
  • Emphysema
  • Bronchitis
  • Asthma
  • COPD
  • Other: _____________
  • GENITO-URINARY
  • Kidney infection
  • Kidney stones
  • Painful urination
  • Prostate trouble
  • Kidney failure
  • CARDIOVASCULAR
  • High blood pressure
  • Arteriosclerosis
  • Angina
  • Poor circulation
  • Rapid heart rate
  • Irregular heartbeat
  • Congestive heart failure
  • Swelling of ankles
  • GASTRO INTERNAL
  • Colitis
  • Constipation
  • Crohn’s disease
  • Ulcerative colitis
  • Diverticulitis
  • Gall bladder disease
  • Hemorrhoids
  • I.B.S.
  • Fissures/fistulas
  • Liver issues
  • Cirrhosis
  • Rectal bleeding
  • Vomiting of blood
  • Cancer
  • Family history of colon cancer
  • Continued
  • Diarrhea
  • Heart burn
  • Excessive belching
  • Excessive gas
  • Depression
  • Dizziness
  • Double vision
  • Enlarged thyroid
  • Fainting spells
  • Fatigue
  • Headaches
  • History of cancer in family
  • History of seizures
  • Insomnia
  • Loss of weight
  • Metal toxicity
  • Candida
  • SIBO

Daily Habits

  • HEAVY MODERATE LIGHT DETAILS
  • Alcohol
  • Coffee
  • Tobacco
  • Drugs
  • Exercise
  • Appetite
  • Sleep
  • Any other health issues: ________________________________________________________________
  • ________________________________________________________________________________________
  • PLEASE READ BEFORE SIGNING:
  • I have honestly answered the above questions and have not intentionally withheld information about my health.

Accomplishments

  • Resolved product issue through consumer testing.

Languages

Spanish
Full Professional
English
Full Professional

Timeline

English Tutor

Home Instead
08.2024 - 05.2025

Medical Technology

Cookeville Highschool

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