Follow the steps to complete the intake form with ease

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering today’s date in the designated space at the top of the form.
3. Fill in your full name, birth date, residential address, phone number, and email address.
4. In the emergency contact section, provide the name and phone number of an individual you trust.
5. Specify the name of your primary care physician and the individual or source that referred you to this service.
6. Indicate your reason for seeking manual lymphatic drainage by selecting either 'therapeutic' or 'medical issue'. If you choose medical issue, state when the problem began and describe its severity and location.
7. List any current medications you are taking, including hormones, vitamins, and nonprescription drugs.
8. Circle 'Yes' or 'No' for each of the major illnesses listed on the form that you may have experienced in the past or currently.
9. Document your surgical history by listing any operations, their dates, reasons, and hospitals where they were performed.
10. Review the current symptoms section and check all that apply to you. This includes general symptoms, reproductive health, and any neurological issues.
11. Provide any additional medical information that you feel is important for the practitioner to know in the designated area.
12. Read the understanding and consent statement carefully. After agreeing, sign and date the form.
13. If applicable, a parent or guardian should provide their signature to authorize treatment of a minor.
14. Once you have completed all sections, save your changes. You may also choose to download, print, or share the form as needed.

Complete your intake form online today to prepare for your appointment.