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Reflexology intake form pdf: >> http://pwi.cloudz.pw/download?file=reflexology+intake+form+pdf << (Download)
Reflexology intake form pdf: >> http://pwi.cloudz.pw/read?file=reflexology+intake+form+pdf << (Read Online)
REFLEXOLOGY HEALTH RECORD. THIS FORM IS TO BE COMPLETED BY THE CLIENT FIRST THEN BY PRACTITIONER FOR INITIAL SESSION. 1. What is your occupation? 2. Are you in good I, the undersigned, consent to reflexology treatment and understand that sessions are for the purpose of stress reduction and
Reiki / Reflexology Services. Client Intake Form. Rev. 12/09/2013. Page 1 of 1. Name: s. Date: Address: City: State: Zip: Home Tel: Mobile Tel: Work Tel: E-Mail: Occupation: Date of Birth: Age: Emergency Contact. Name/Phone/Relation: Would you like to be emailed announcements about events or discounts? Yes / No.
Do you have/or have you had any blood clotting issues? Yes No. (Reflexology improves/increases circulation. If dealing with any clotting issues a. Doctor should be consulted). (Women) Are you or could you be Pregnant? Yes No. Do you have any contagious skin conditions on or around your lower leg/ankle/feet? Yes No.
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You need to know that: 1. I am not a doctor. 2. I do not practice medicine. 3. I do not diagnose or treat for a specific illness. 4. I do not prescribe or adjust medication. 5. Reflexology is not a substitute for medical treatment, but is a complement to most types of therapy. What is Reflexology? Reflexology is an ancient, manual
Do you have circulatory problems? Yes__ No__. What/When? Do you have a pacemaker? Yes__ No__. What/When? Are you pregnant (women). Yes__ No__. What/When? Do you smoke? Yes__ No__. What/When? Any history of cancer? Yes__ No__. What/When? Do you have diabetes? Yes__ No__. What/When?
What Is Reflexology? Reflexology is an ancient, manual technique based upon the concept that the entire body is reflected as a system of reflexes on the feet (hands and ears as well). By pressing on these reflexes with fingers, one is able to bring about relaxation and balance in the body, and also assist in overall stress
A UNIVERSAL COLLEGE OF. Confidential Client Health History. REFLEXOLOGY. Name: Address: Postal Code: How Did You Hear About My Services: Home Phone #:. Work #:. Cell #:. Email : _Weight: Male / Female Birth Date: # of Children. Occupation: Comments / Notes of Caution. Age: L Height: . Ages of Children:.
Continued on page 2. This and all forms are the property of Healthy Life Chiropractic ~ 2753 E. Highway 34, Ste 1 ~ Newnan, GA 30265 ~ 770-252-3661. Reflexology Intake Form. Office Use Only. Appointment time:
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