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Health History 2020

Personal Info
Contact Info
Emergency Contact
Doctor
Other
Medical Info
Insurance Info
Conditions
Health Questions
Energy
Treatment Goals
Emotion / Memory
SP/ST (Earth)
HT/SI (Fire)
Energy Level
Well Being
TMJ (Jaw)
LIV/GB (Wood)
Feet
LU/LI (Metal)
Infectious
Female Health
COVID-19 Questionnaire (Check Appropriate Boxes to Comment Below)
Oncology
Infant
Area of Complaint
Brain Disorders
Headaches
Musculoskeletal
Cardiovascular
Blood
Respiratory
Neurological
Hearing
Skin
Reproductive
Family History
Immune
Kidney
Gastrointestinal
Endocrine
General Injury Related Questions
Eating Habits
Prenatal (check boxes to enter details below)
Massage Goals
Accident Info
Which best describes what you are experiencing
Current Complaint
Physical Activities You Participate In
Number of Times of Week You Practice
Allergy
Emotion / Mood
Review, Accept and Sign