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  • Reflexology Questionnaire PDF

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    Hansgebiebche
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    European Massage Therapy provides massage therapy services in Calgary, Alberta, Canada. The document includes contact information for European Massage Therapy and asks clients questions about their medical history and current health conditions. It concludes by having the client declare that the provided medical information is accurate and agree to inform the massage therapist of any health changes before future appointments.

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    Reflexology-Questionnaire.pdf

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    European Massage Therapy provides massage therapy services in Calgary, Alberta, Canada. The document includes contact information for European Massage Therapy and asks clients questions about their medical history and current health conditions. It concludes by having the client declare that the provided medical information is accurate and agree to inform the massage therapist of any health changes before future appointments.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    431 views1 page

    Reflexology Questionnaire PDF

    Uploaded by

    Hansgebiebche
    European Massage Therapy provides massage therapy services in Calgary, Alberta, Canada. The document includes contact information for European Massage Therapy and asks clients questions about their medical history and current health conditions. It concludes by having the client declare that the provided medical information is accurate and agree to inform the massage therapist of any health changes before future appointments.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    European Massage Therapy

    1829 Ranchlands Boulevard NW 2nd floor Unit 231 Calgary, AB Phone: (587) 227 4238 Homepage: www.europeanmassage.ca Email: d.cieslak-verheyen@hotmail.com
    Reg. & licensed Massage Therapist and Member of NHPC

    Additional Questions for Reflexology


    Do you have any of the following diseases?

    - Acute inflammation of the veins and lymphatic system: - Highly infectious and febrile diseases: - Gangrene in the foot: - Psychosis (except the sick are cared for medically targeted): - Risk pregnancy: - Rheumatic diseases, the impact on the ankles acutely:

    Yes______ Yes______ Yes______ Yes______ Yes______ Yes______

    No______ No______ No______ No______ No______ No______

    --------------------------------------------------------------------------------------------------------------------------------------------------I, hereby declare the information on this form to be true and correct in all respects. Should my current health status change in the future, I will inform the Massage Therapist about it before my next appointment. I understand that the Massage Therapist relies on the information given by me; in order to provide safe treatment. If any of the given information is incorrect, I hereby release the Massage Therapist from any claims that may arise of the treatment provided.

    --------------------------------------------Date -------------------------------------------Name (please print) -------------------------------------------------Signature

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