Intake Forms

An accurate health history is important to ensure that it is safe for you to receive a massage treatment. If your health status changes in the future, please let me know. All information gathered for this treatment is confidential except as required or allowed by law or except to facilitate diagnosis (assessment) or treatment. You will be asked to provide written authorization for release of any information.

Please click on the left image above to download the Case History (pdf).  Bring the completed Case History form with you when you arrive for your appointment.

Please click on name of the form above to download either the Patient or Pediatric Intake Forms.  Bring the completed applicable form with you when you arrive for your appointment.

Please click on the right image above to download the Physio Case History (pdf).  Bring the completed Physio Case History form with you when you arrive for your appointment.

Stretches

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