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Health Intaking Form - Bodywork Clients
Please answer briefly and accurately so I can best assist you and your goals

This form should take 1-5 minutes. Please fill out or update before every session.
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Full name *
Contact Phone Number *
1. List Medications + Brief Reason 
2. Any active or Chronic Health Diagnoses? (Ex. Hypertension, Diabetes, Cancer, etc.)
3. Any Concerns, Pain, or Injuries?
4. Any Surgeries? (Spinal Fusion, Tumor Resection, etc.)
5. Allergies to Scents, Oils, Cleaning Supplies, Foods, or Materials? *
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