Reflexology intake form pdf

This is the common type of massage intake form that can be provided to all massage clients. Oncology massage intake form must accompany a complete. Use amtas client intake forms to fully understand your client before you begin your first massage session. I understand that massage and reflexology are compliments to healthcare and not a substitute for medical supervision of any condition. Each recorded reflexology session will be referred to as a reflexology session record, not a treatment or medical record.

Welcome to healing powers reflexology 242 heritage park dr, suite 104, murfreesboro, tn 37129. I understand that i may discontinue a session or sessions at any time. The form has four sections namely the client information section, session information section, previous history section, and an acknowledgment section. Whether you are just researching or interested in making your first appointment, well walk you through every step of the way. The reflexology session what can one expect usually, a session begins with a client health intake and interview. If i have any medical condition that requires a physicians care, i have consulted himher regarding receiving a massagereflexology.

I have stated all my known medical conditions and take it upon myself to keep the reflexologist updated on my physical health. Protect yourself, your clients and your massage therapy practice by utilizing proper documentation techniques. 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. 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. If i experience any pain or discomfort during this session, i will immediately inform the therapist lia digiacomo and or michael p. Stones are heated and used with oils to sooth, warm, and massage your muscles. If you have just started practicing reflexology, it.

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. The most common is a healthcare patient intake form which is used by doctors, nurses, and hospital staff. Reflexology client intake form family chiropractic. Please answer the questions below so that we can thoroughly address your needs. A separate form is required before receiving manual lymphatic drainage. A referral from your primary care provider may be required prior to service being provided. Keep track of your massage clients condition and progress with sample soap notes. Reflexology treatment consent and intake form form mobile app. Phone occupation date of birth work age please circle he appropriate answers if you have had any of the following conditions.

Balanced bodycare, pllc holly glennon rnbsn, lmt nationally certi. An informed consent and waiver form should also be enclosed with the therapy intake form to assure that the. 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. Please answer questions to the best of your knowledge.

If you are a new client booking reflexology with robyn harding please fill out this reflexology intake form pdf. This allows your body to relax and release tension and stress. Reflexologyenergy work waiver and consent form thank you for choosing natural wellness centre for your reflexologyenergy work therapy. Hot stone massage is often paired with swedish massage. Our members get exclusive access to all the original files to fully customize however. I understand that the massage bodywork i receive is provided for the basic purpose of relaxation and relief of muscular tension. By signing this form, i certify that the above information is correct to the best of my knowledge. Client information form reflexology r don t hurt me. Client intake form reflexology personal information. Reflexology stimulates circulation and the delivery of oxygen and nutrients to the cells. 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 have completed this form to the best of my knowledge and will inform the massage therapist of any change in 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. Please take a moment to read the following information.

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. This form of practice is carried out using maps having predefined points located on your feet. If yes, please complete the billing information form. Reflexology promotes balance and normalization of the body naturally. This is why reflexology can be a very effective technique for good health, preventing symptoms of stress and illnesses from surfacing. She will also inform you that reflexology does not treat specific. 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. 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. Reflexology health form awakened soles reflexology. This has two sections mainly patient information and an agreement section. Heart problems drug dependence alcohol dependence caffeine dependence history of abuse. The reflexology component of the exam will involve questions about reflexes to work for specific conditions. May 07, 2019 international academy of reflexology and meridian therapy application 2020 pdf form, university of reflexology application requirements 20202021. I understand that massage and reflexology are compliments to healthcare and not a substitute for medical.

See more ideas about massage, massage intake forms and massage therapy. 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. First time clients centralpenn central penn reflexology. The varieties of patient intake forms are only a few. Even though reflexology is a form alternate medicine, it is based on years of scientific and medical research. Rest assured that your information is confidential. I may stop the session at any time, either during the assessment or the treatment. Alle es asthma back pain cancer diabetes sciatica stress varicose veins arthritis bursitis. There will be a charge of up to 75% of your appointment if you fail to cancel your. Reflexology is a type of massage that involves applying different amounts of pressure to the feet, hands, and ears. Reflexology reduces stress and brings about relaxation. Your reflexologist will explain what to expect in the session and answer any questions you may have. Contract for services by signing this form, i give my consent to a reflexology session.

Thank you for taking the first step in taking care of your health with reflexology. University of reflexology 20202021 intake deadline is the day that the university of reflexology 202020212020 admission applications. A basic health form for informational background on you before proceeding with a reflexology session. Another variety is an insurance patient intake form which is provided by the patients health insurance provider. A reflexologist is not a medical doctor, therefore does not diagnose, prescribe or treat for a specific condition. Please answer the questions to the best of your knowledge. If you have to cancel your appointment, we ask that you do so 24 hours in advance. 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. The information on this page will walk you through. In accordance with the law, massage therapybodywork cannot cure, treat, prevent or diagnose any condition. I have stated all of my known medical conditions on the client intake form. Please mark c next to the currentchronic issues below and p next to those youve had in the past.

This is the reason why massage centers and sessions are available in order for people to have a quiet and stressfree time for themselves. Its based on a theory that these body parts are connected to specific organs and body systems. Reflexology helps increase blood supply to the tissues and all parts of the body and stimulates the nerve impulses that aid in the bodys internal communication through helping the body relax and release tension. Hand reflexology session records order form 17 iii. Ganci so that the pressure and or strokes may be adjusted to my level of comfort. Client intake form therapeutic massage personal information. Should you find you will be arriving a bit late for your appointment, the courtesy of.

Moreover, reflexology is an entirely different practice than that of massage. It is our goal to provide you the most therapeutic experience possible. I understand that it is solely my responsibility to keep the therapist updated on any changes in my physical health and i. Clients can sign off on the form electronically, making it easy to speed up the intake process and begin.

Client intake form reflexology holistic health and fitness. Online booking is not supported by microsoft edge or internet explorer. Microsoft word gi patient intake questionnaire1 created date. 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. For the provision of professional reflexology health care services provided to you. If i have been diagnosed by a licensed health professional. All the information in reflexology is valid and meaningful. Reflexology treatment consent and intake form form mobile. By signing this form, i give my consent to a reflexology session.

Free forms massage therapy business, massage marketing. Reflexology energy work waiver and consent form thank you for choosing natural wellness centre for your reflexology energy work therapy. Underline past conditions check here if explanation below. Save time and get started right away on your first visit by filling out an intake form. Reflexology client form under, do not resell or distribute these files. International academy of reflexology and meridian therapy application 2020 pdfform, university of reflexology application requirements 20202021. For detailed information on course and subject requirements, please see other.