Gabrielle Brown-Wing, LMT
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Medical Info
Primary Complaint
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General Health
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Medications
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Conditions
Health Questions
Epilepsy
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Schizophrenia
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Hearing Impairment
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Stroke
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Heart Attack
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Vertigo
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Heart Condition
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Asthma
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Meniere Disease
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Concussion
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Mood Disorder
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Congenital Heart Defect
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Pacemaker
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Depression
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Past Heart Surgery
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Genetics
Loeys-Dietz Syndrome
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Marfan Syndrome
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Mitochondrial Disease
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Ehlers-Danlos Syndromes
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Other
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Well Being
Exercise
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Flexibility
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Hobbies
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Mobility/Walking Aids
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Range of Motion
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Sports
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Oncology
Cancer Type
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Location
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Status
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Treatment: Surgery
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Date of Surgery
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Lymph Nodes Removed
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Reconstruction Date
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Treatment: Chemotherapy
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Treatment: Radiation
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Area of Radiation
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Nodes Irradiated
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Other Treatments
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Medical Devices
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Area of Complaint
Neck
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Left Side of Neck
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Right Side of Neck
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Upper Back
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Left Side of Upper Back
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Right Side of Upper Back
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Mid Back
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Left Side of Mid Back
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Right Side of Mid Back
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Low Back
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Left Side of Low Back
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Right Side of Low Back
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Chest
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Abdomen
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Left Arm
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Right Arm
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Left Shoulder
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Right Shoulder
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Left Elbow
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Right Elbow
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Left Wrist
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Right Wrist
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Left Hand
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Right Hand
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Left Leg
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Left Thigh
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Left Calf
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Right Leg
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Right Thigh
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Right Calf
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Left Gluteal
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Right Gluteal
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Left Hip
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Right Hip
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Left Groin
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Right Groin
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Left Knee
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Right Knee
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Left Ankle
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Right Ankle
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Left Foot
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Right Foot
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Sacrum
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Tailbone (coccyx)
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Neurological
Post Polio Syndrome
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Syringomyelia
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Cerebral-vascular Accident
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Fibromyalgia
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Sciatic Pain
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Bell's Palsy
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Tethered Cord
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Cerebrospinal Fluid Leak
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Herniated Disc
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Seizure Disorder
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Brain Disorder
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Tingling
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Chiari Malformation
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Huntington Disease
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Shingles
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Brain Injury
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Transient Ischemic Attacks (TIA)
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Chronic Pain Disorder
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Loss of Sensation
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Shingles / Herpes
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Burning
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Twitching of Face
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Dizziness
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Multiple Sclerosis
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Sleeping Disorders
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Carpal Tunnel
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Vertebral and Spinal Cord Injury
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Dural Ectasia
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Numbness
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Stabbing
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Cerebral Palsy
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Epilepsy
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Parkinsons
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Peripheral Neuropathy
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Stroke
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Cerebral Vascular Accident (Stroke)
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Fatigue
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Other Neurological
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Musculoskeletal
Compartment Syndrome
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Hereditary/Congenital Deformity
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Osteomalacia
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Artificial Joints / Special Equipment
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Sinus Problems
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Degenerative Disk Disease
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Jaw Pain (TMJD)
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Osteoporosis
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Baker's Cyst
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Spasms / Cramps
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Dislocation
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Joint Injury
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Paget Disease
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Bone Disease
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Spondylolisthesis
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Strain/Sprain
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Dupuytren's Contracture
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Joint Stiffness / Swelling
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Adhesive Capsulitis
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Plantar Fasciitis
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Bone or Joint Disease
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Temporomandibular Joint Dysfunction
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Ehlers-Danlos Syndrome
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Muscular Dystrophy
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Amyotrophic Lateral Sclerosis (ALS)
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Psoriatic Arthritis
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Broken Bone / Fracture
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Tendonitis/Bursitis
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Fibromyalgia
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Myasthenia Gravis
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Ankylosing Spondylitis
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Recti Diastasis
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Carpal Tunnel Syndrome
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Torticollis
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Fracture
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Osgood-Schlatter Disease
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Arthritis
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Scleroderma
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Chronic Fatigue Syndrome
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Chronic Myofascial Pain Syndrome
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Whiplash
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Gout
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Osteoarthritis
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Scoliosis
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Other Musculoskeletal
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Skin
Bruise Easily
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Rosacea
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Eczema
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Severe Irritability
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Hypersensitive Reaction
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Surgical Scars
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Infectious Skin Conditions
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Melanoma
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Non-Surgical Scars
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Psoriasis
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Allergic Dermatosis
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Rash
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Miscellaneous
Contact Lens
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Hearing Impaired
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Loss of Balance
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Visually Impaired
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Weakened Immune Function
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Other Medical Conditions
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Massage Goals
Increase Well-Being
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Injury Rehabilitation
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Positive Reinforcement
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Address Health Issues
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Strength Training
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Alternative Therapy
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Stress Relief
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Balance
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Flexibility
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Improve Fitness
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Date of Last Massage
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Massage Frequency
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Light Pressure Preferred
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Medium Pressure Preferred
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Other
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Deep Pressure Preferred
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Allergy
Environmental
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Food
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Latex
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Mastocytosis
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MCAD
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Medical
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Miscellaneous
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