Reflexology intake form pdf

Please mark c next to the currentchronic issues below and p next to those youve had in the past. Our members get exclusive access to all the original files to fully customize however. Hand reflexology health and session records as part of the certification process for becoming a certified hand reflexologist, the student must complete the following practicum procedures as part. It is our goal to provide you the most therapeutic experience possible. Free forms massage therapy business, massage marketing. Contract for services by signing this form, i give my consent to a reflexology session. Client intake form therapeutic massage personal information. Balanced bodycare, pllc holly glennon rnbsn, lmt nationally certi. May 07, 2019 international academy of reflexology and meridian therapy application 2020 pdf form, university of reflexology application requirements 20202021. Whether you are just researching or interested in making your first appointment, well walk you through every step of the way. Phone occupation date of birth work age please circle he appropriate answers if you have had any of the following conditions. Sessions are scheduled with generous time for unhurried ease of transition between clients. This has two sections mainly patient information and an agreement section.

This is the reason why massage centers and sessions are available in order for people to have a quiet and stressfree time for themselves. If i experience any pain or discomfort during this session, i will immediately inform the therapist lia digiacomo and or michael p. Reflexology client intake form family chiropractic. The information on this page will walk you through. Client intake form reflexology holistic health and fitness. I understand that massage and reflexology are compliments to healthcare and not a substitute for medical. By signing this form, i certify that the above information is correct to the best of my knowledge. I have stated all my known medical conditions and take it upon myself to keep the reflexologist updated on my physical health. Also known as client intake form, a massage intake form is a way by which therapists record patient contact information, specify policies, and get an idea of the patients issues, medications, and contraindications.

If you have to cancel your appointment, we ask that you do so 24 hours in advance. This is why reflexology can be a very effective technique for good health, preventing symptoms of stress and illnesses from surfacing. Name phone day phone eve address citystatezip email date of birth occupation emergency contact phone the following information will be used to help plan safe and effective massage sessions. There will be a charge of up to 75% of your appointment if you fail to cancel your. All the information in reflexology is valid and meaningful. Please take a moment to read the following information. If you are a new client booking reflexology with robyn harding please fill out this reflexology intake form pdf. Welcome to healing powers reflexology 242 heritage park dr, suite 104, murfreesboro, tn 37129.

Your reflexologist will explain what to expect in the session and answer any questions you may have. Each recorded reflexology session will be referred to as a reflexology session record, not a treatment or medical record. Reflexologyenergy work waiver and consent form thank you for choosing natural wellness centre for your reflexologyenergy work therapy. Online booking is not supported by microsoft edge or internet explorer.

International academy of reflexology and meridian therapy application 2020 pdfform, university of reflexology application requirements 20202021. The reflexology session what can one expect usually, a session begins with a client health intake and interview. If yes, please complete the billing information form. For the provision of professional reflexology health care services provided to you. Moreover, reflexology is an entirely different practice than that of massage. Heart problems drug dependence alcohol dependence caffeine dependence history of abuse. Personal information includes all the ilformation that you provided to us on our client information healthmedical history form at the first visit and any subsequent visits. Massage and bodywork intake form client information name city state zip date day phone eve phone occupation date of birth emergency contact name and phone. I understand that a massage therapist can not diagnose illness, disease, or any other medical, physical, or emotional disorder, nor perform any spinal manipulations.

I may stop the session at any time, either during the assessment or the treatment. A separate form is required before receiving manual lymphatic drainage. I further understand that reflexology should not be construed as a substitute for medical examination, diagnosis or treatment and that i should see a physician, chiropractor or other qualified medical speciali st for any mental or physical ailment of. Reflexology health form awakened soles reflexology. Should you find you will be arriving a bit late for your appointment, the courtesy of. Microsoft word gi patient intake questionnaire1 created date. If you have just started practicing reflexology, it. Please answer the questions to the best of your knowledge. Hand reflexology session records order form 17 iii.

The reflexology component of the exam will involve questions about reflexes to work for specific conditions. A reflexologist is not a medical doctor, therefore does not diagnose, prescribe or treat for a specific condition. A basic health form for informational background on you before proceeding with a reflexology session. Client intake form reflexology personal information. Wellness center consent form i certify that the above information is correct to the best of my knowledge.

Generally, therapists require patients to fill out the massage intake form before their appointment. Even though reflexology is a form alternate medicine, it is based on years of scientific and medical research. First time clients centralpenn central penn reflexology. By signing this form, i give my consent to a reflexology session.

This easytocustomize client intake form for reflexology services covers all important client details, including reasons for seeking treatment, a brief medical history, existing medical conditions and medications, and contact details. Oncology massage intake form must accompany a complete. Reflexology stimulates circulation and the delivery of oxygen and nutrients to the cells. Reflexology energy work waiver and consent form thank you for choosing natural wellness centre for your reflexology energy work therapy. See more ideas about massage, massage intake forms and massage therapy. Clients can sign off on the form electronically, making it easy to speed up the intake process and begin. Rest assured that your information is confidential. I understand that the massage bodywork i receive is provided for the basic purpose of relaxation and relief of muscular tension. Another variety is an insurance patient intake form which is provided by the patients health insurance provider. Please answer questions to the best of your knowledge. This allows your body to relax and release tension and stress. Our members get exclusive access to all the original files to fully customize however they please plus.

I have completed this form to the best of my knowledge and will inform the massage therapist of any change in my physical health. Ganci so that the pressure and or strokes may be adjusted to my level of comfort. Reflexology is a type of massage that involves applying different amounts of pressure to the feet, hands, and ears. Healing powers reflexology intake form pdf download. I have completed this form to the best of my ability and knowledge and agree to inform my reflexologist if any of the above information changes at any time. Alle es asthma back pain cancer diabetes sciatica stress varicose veins arthritis bursitis. She will also inform you that reflexology does not treat specific. Stones are heated and used with oils to sooth, warm, and massage your muscles. The school or instructor must complete an arcb school verification form that states the program is a combined program that covers the required course and subject components and verifies the number of classroom instruction hours dedicated to hand reflexology. The form has four sections namely the client information section, session information section, previous history section, and an acknowledgment section. An informed consent and waiver form should also be enclosed with the therapy intake form to assure that the. For detailed information on course and subject requirements, please see other. Reflexology treatment consent and intake form form mobile. Its based on a theory that these body parts are connected to specific organs and body systems.

Keep track of your massage clients condition and progress with sample soap notes. I understand that i may discontinue a session or sessions at any time. In accordance with the law, massage therapybodywork cannot cure, treat, prevent or diagnose any condition. We are pleased to keep you informed about university of reflexology 20202021 application requirements, university of reflexology online application 20202021, university of reflexology application form 20202021 pdf, admission requirements. Save time and get started right away on your first visit by filling out an intake form. Client information form reflexology r don t hurt me. If i have any medical condition that requires a physicians care, i have consulted himher regarding receiving a massagereflexology.

This is the common type of massage intake form that can be provided to all massage clients. Reflexology client form under, do not resell or distribute these files. I understand that it is solely my responsibility to keep the therapist updated on any changes in my physical health and i. Thank you for taking the first step in taking care of your health with reflexology.

I have consulted a medical doctor or licensed medical health care practitioner regarding any checked or described conditions. Reflexology reduces stress and brings about relaxation. Please answer the questions below so that we can thoroughly address your needs. I understand that massage and reflexology are compliments to healthcare and not a substitute for medical supervision of any condition. Protect yourself, your clients and your massage therapy practice by utilizing proper documentation techniques. Hot stone massage is often paired with swedish massage. If i have been diagnosed by a licensed health professional. The varieties of patient intake forms are only a few.

Underline past conditions check here if explanation below. I have stated all of my known medical conditions on the client intake form. Since the therapy intake form will gather the personal information of the client, it is significant that the therapist has acquired the clients legal consent to use all the statements and details that the client disclosed in the form. Use amtas client intake forms to fully understand your client before you begin your first massage session. University of reflexology 20202021 intake deadline is the day that the university of reflexology 202020212020 admission applications. Reflexology promotes balance and normalization of the body naturally. This form of practice is carried out using maps having predefined points located on your feet. A referral from your primary care provider may be required prior to service being provided. Reflexology treatment consent and intake form form mobile app.