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Health History Form

Health History Form The information request below will assist us in treating you safely. Feel free to ask any questions about the information being requested.

Training Institute on Youth Who Sexually Offend

Sample of 222 minor boys (17 or younger) found ... as school- 1 st occurred with girlfriend, claims a massage ... Intake: 3/5/06, came to our group home from a ...

Intake Form

1 Intake Form 7Song, Clinical Herbalist P.O. Box 6626 Ithaca, NY 14851 607-539-7172 www ... Counsel ing ____Herbal ist ____Homeopath ____Naturopath ____Social Worker ____Massage ...

Massage Intake form

Natural Elements Health Center Natural Elements Health Center Natural Elements Health Center Natural Elements Health Center 900 Hwy 23 Suite 3 Milaca, MN 56353 320 ...

Genitourinary

... firm or boggy, warm and tender Avoid vigorous massage, it ... generally suggest that women submit a urine sample for ... In women, these supports form a two-layered hammock ...

Massage Intake form

Natural Elements Health Center Natural Elements Health Center Natural Elements Health Center Natural Elements Health Center 900 Hwy 23 Suite 3 Milaca, MN 56353 320.983 ...

Client Information Sheet

What is your daily intake of pure water? (Do not include fruit juice/herbal tea/coffee) 2 litres 1 Litre 500ml Less Briefly describe your diet: _____

General and Medical Information

Massage Client Intake Form Massage Client Waiver Form Please take a moment to read and initial all of the following statements: If I experience pain or discomfort during the ...

Leading the Way: Managing Multiple Myeloma for the Long -Term

... Registration and Program Evaluation Form found in your ... g/dL, light chain u003E1 g/dL in 24-hour urine sample. ... Gentle massage of affected areas with cocoa butter ...

Massage Therapy Intake Form

Massage Therapy Intake Form Name:_____ Date of Birth:_____ Home Phone ...

Intake Form

1 Intake Form 7Song, Clinical Herbalist P.O. Box 6626 Ithaca, NY 14851 607-539-7172 www. 7Song@light link. com Please Note . This detailed intake form has many questions ...

Confidential Client Intake Form

Confidential Client Intake Form NAME _____ First MI Last ADDRESS ...

Massage and Bodywork Intake Form

Massage and Bodywork Intake Form Client Information Name City State Zip Date Day Phone ( ) Eve Phone ( ) Date of Birth Occupation Emergency Contact Name and ...

Can you Afford Not to Record

Microsoft PowerPoint - ANNETTE WINCH - Documentation for the Massage Practitioner.pps

New Client Info/Consultation Form

New Client Info/Consultation Form . Instructions for submitting: Use your word processor to fill out this form and save it as a file on your computer.

Sample Customer Intake Form (from NStep)

RAAHC Personal Profile Intake Form . APPLICANT Please Print Clearly. Name: _____ First MI Last

Therapeutic Massage Client Intake Form

Therapeutic Massage Client Intake Form Personal Information Name ... Circle any specific areas you would like the massage therapist to concentrate on ...

www.prochairmassage.com

Pro Chair Massage . INFORMED CONSENT . I hereby consent to treatment by the Massage ... I intend for this consent form to cover the entire course of treatment for my ...

Differential Mental Health Assessment in Older Adults

... dehydration and lack of appropriate diet vitamin intake ... and Memory Study (Plassmana, Et al., 2007) sample was ... and the Michigan Alcohol Screening Test-Short Form ...

Intake Form

Indulge Spa Intake Form Name: Date: Occupation: Address: Phone: Date of Birth: City: State: Zip ... List the medications you are currently taking: massaGe tHerapy Goal For your massaGe ...

Complementary and Alternative Medicine in Womens Health

... Drugs Manipulative-Based Therapies Chiropractic Massage ... patient history Add CAM questions to current intake form ... studies Double-blinded study is difficult Small sample ...

Chair Massage Client Intake Form

Massage Client Intake Form . Name:_____ Address:_____ City ...

Osteoporosis Stress overwhelming repair

In trabecular bone the fibrils are arranged to form a ... Images are taken within 2x2 mm on the same bone sample: ... with water throughout the day, extra water intake ...

Consultation Form

Zenith Therapy Consultation Form ... Fluid intake per day what types: Balanced (please write a typical day of ...

Early Intervention with Children in Substance Abusing Families ...

... Development Center Pediatric Intake; Parent-Child Relationship Scale and Manual ... component continues to build sample ...

Balanced Body Massage Client Intake Questionnaire PLEASE PRINT ...

Balanced Body Massage Client Intake Questionnaire P LEASE P RINT N EATLY ! Name _____ Address ...

Client Release Form

Client Release Form . Massage Therapy . I understand that the massage therapy given here is for the purpose of stress reduction, relief from muscular tension or ...

Joe R. Campbell BS, LMT, LMTI, CEP CONFIDENTIAL CLIENT HISTORY ...

Joe R. Campbell BS, LMT, LMTI, CEP CONFIDENTIAL CLIENT HISTORY/INTAKE FORM Last Name ... (initial) (initial) Primary reason for getting massage: Pain Relief Sports ...