Trusted Bodywork health & treatment
Confidential client health & treatment
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Email *
First name *
Last name *
Date of birth *
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Treatment date *
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Desired outcome *
Reason for seeking treatment *
Have you had a professional massage? *
Was it Jing method?
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What did you like in your massage?
Choose from my playlists(listen on my Playlists page) or give me the public URL to your own in "Other" *
Allergies *
Are or could you be pregnant? *
DVT/blood clot risk? *
Infection/colds/fever in past week? *
Close contact with anyone CURRENTLY tested positive for COVID-19 in the past 14 days? (testing positive for antibodies is fine) *
Required
Skin conditions
Current medical conditions diagnosis
Current medication or supplements. How do they make your feel? Any noticeable side effects?
Current medical and complimentary health professionals
A copy of your responses will be emailed to the address you provided.
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