Body Therapeutics Confidential Health History Form

Please download, print and bring it to your appointment.

I have requested treatment and confirm that the above information is correct. I understand that massage/energy practitioner does not diagnose disease, illness or any other physical or mental disorder.

The practitioner does not prescribe medical treatment, pharmaceuticals, nor do they perform any spinal or skeletal adjustments. This treatment is not a substitute for medical examination, and it is recommended that I see a physician for an ailment I might have.