Massage Medical History Form
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How to write a Massage Medical History Form? Download this Massage Medical History Form template that will perfectly suit your needs.
Our collection of online health templates aims to make life easier for you. Our site is updated every day with new health and healthcare templates. By providing you this health Massage Medical History Form template, we hope you can save precious time, cost and efforts and it will help you to reach the next level of success in your life, studies or work!
Massage Client Health History Form Client Information and Release Form Name Birth Date Address City State Zip Phone Number(s) Home Work Cell E-mail Address Referred By Is this your first massage General Medical History Check the box if you have or have had recent problems with any of the following: □ □ □ □ □ □ □ □ □ Arthritis Bursitis Back Pain Neck Pain Arms / Hands (Pain) Hips / Legs / Feet (Pain) Headaches Swollen Joints Fibromyalgia □ □ □ □ □ □ □ □ □ High Blood Pressure Low Blood Pressure Poor Circulation Anemia Stroke Chest Pain Seizures / Convulsions Heart Conditions Constipation □ □ □ □ □ □ □ □ □ □ Sinus / Allergies Hematomas Phlebitis Vericose Veins Cancer Skin Conditions Pregnant of months Menstrual Pain Warts Athlete’s Feet Please circle any areas of pain, injury, tension, or restriction of movement..
This Massage Medical History Form is intuitive, ready-to-use and structured in a smart way. Try it now and let this Massage Medical History Form sample inspire you.
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