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Health History 2020

Personal Info

Contact Info
Emergency Contact
Doctor

Medical Info

Insurance Info

Conditions

Emotion / Memory
Female Health
Oncology
Energy Level
Energy
Feet
Well Being
TMJ (Jaw)
LIV/GB (Wood)
LU/LI (Metal)
HT/SI (Fire)
SP/ST (Earth)
Treatment Goals
Infectious
Health Questions
COVID-19 Questionnaire (Check Appropriate Boxes to Comment Below)
Infant
Brain Disorders
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
Area of Complaint
Headaches
Family History
Blood
Cardiovascular
Endocrine
Gastrointestinal
Hearing
Immune
Kidney
Musculoskeletal
Neurological
Reproductive
Respiratory
Skin

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