Need Help? Call: 509-723-4128

Intake Form 2020

Personal Info
Contact Info
Emergency Contact
Doctor
Other
Medical Info
Insurance Info
Conditions
Health Questions
Infectious
Genetics
Emotion / Memory
COVID-19 Questionnaire (Check Appropriate Boxes to Comment Below)
Infant
Area of Complaint
Brain Disorders
Headaches
Immune
Blood
Musculoskeletal
Skin
Cardiovascular
Neurological
Reproductive
Respiratory
Endocrine
Kidney
Massage Goals
Accident Info
Which best describes what you are experiencing
Current Complaint
Allergy
Review, Accept and Sign
Review
Accept