Get Cnw Student Clinic Confidential Client Intake Form

Completing the CNW Student Clinic Confidential Client Intake Form online is an essential part of ensuring your experience at the clinic is tailored to your needs. This guide will provide you with clear and supportive instructions to help you fill out each section accurately and efficiently.

Follow the steps to complete your client intake form online.

1. Click 'Get Form' button to obtain the form and open it in your preferred editor.
2. Begin by entering your personal information. Fill in your name, date, address, city, state, zip code, occupation, and various phone numbers in the designated fields. Make sure the information is current and accurate.
3. Provide your birthdate, height, weight, and gender. For gender, select the appropriate option using M for male or F for female.
4. Enter your email address and provide the name and phone number of your emergency contact.
5. In the statement of intoxicants section, indicate whether you have consumed any intoxicating substances before your appointment by initialing 'Yes' or 'No'. If yes, specify the substance consumed.
6. Indicate whether you have ever received a professional massage by selecting 'Yes' or 'No'. If 'Yes', provide details on frequency and type, along with the date of your last massage.
7. Describe what results you hope to achieve from your massage in the space provided.
8. If you are currently seeing a medical specialist, please explain the reason.
9. List any current medications, including over-the-counter drugs, supplements, and herbs.
10. Provide information on your stress reduction and exercise activities, including frequency.
11. Complete the medical history section by listing any allergies, surgeries, accidents, injuries, or illnesses.
12. In various health categories such as musculoskeletal, circulatory, urinary, and others, mark 'Past' or 'Current' next to any applicable conditions.
13. Review the statement regarding your choice to receive massage therapy and ensure you understand the limitations. Then, provide your signature and the current date to acknowledge your agreement.
14. After filling out the form, save your changes. You can then download, print, or share the completed form as applicable.

Complete your CNW Student Clinic Confidential Client Intake Form online today to ensure a personalized and effective experience.