Medical Information for English Osteopath
everything you write will be treated in the strictest confidence
Email address *
Name
Age
Please let me know about any pain/problems/aches that you have currently, Describe them and give information on when they started and why they started, if known, plus how they affect your day to day life.
Please write about your medical history, include any accidents, broken bones, hospital visits, allergies, operations with approx dates.
What sports or exercise do you do and how regularly do you do this?
Are you currently taking any prescribed or non prescribed medicine. If so which ones and what dosage?
Mental health is part of general health, we can advise on counsellors/therapists/websites if you need. Please let us know here or when in consultation.
Is there anything further relating to your health or proposed osteo session with us that you'd like to mention
Thank you, please submit this form and I look forward to meeting with you soon.
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