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To register to our Massage & Manual Therapy please fill out the following medical form

HEALTH Information  FORM

A: Client Information

B : Health Informations (Past or Current, Dates, Any Treatments)

How would you rate your general health?
How would you described your Stress Level?
How would you described your PAIN Level?
Have you had Massage Theray or Manual Therapy before?

C : Health Information Checklists 

HEAD and NECK
NERVOUS SYSTEM
MUSCULOSKELETAL SYSTEM : (Muscles, Bones, Joints)
OTHER CONDITIONS
RESPIRATORY
CARDIOVASCULAR SYSTEM
SKIN & INFECTIONS
REPRODUCTIVE SYSTEM
Please read the following, initial and sign below:

Thank you.Your information has been successful submitting. Now you can schedule your appointment byText / Call 949-656-9429We will get back to you within 24 hours.

© 2020 by PainRelief 159

To Schedule An Appointment

Call 949.656.9429​

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