Get Az Martha Reamy Lymphatic Massage Client Intake Form 2022-2025

The AZ Martha Reamy Lymphatic Massage Client Intake Form is an essential document designed to gather important information about clients seeking lymphatic massage therapy. Completing this form accurately ensures the practitioner is informed about your health history and specific needs, helping you receive the most effective care.

Follow the steps to fill out the form online

1. Click ‘Get Form’ button to access and open the form in your preferred editing tool.
2. Fill in the confidential client information section, starting with today’s date followed by your name, birth date, address, phone number, and email address. Make sure all details are accurate.
3. In case of emergency, provide the name and phone number of a contact person. This information is vital for addressing any unforeseen circumstances.
4. Enter the name of your primary care physician and who referred you to the practitioner, if applicable.
5. Indicate the reason for seeking manual lymphatic drainage by checking either ‘Therapeutic’ or ‘Medical Issue’. If you select a medical issue, please specify when the issue started and describe the problem, including its location and severity.
6. List any current medications you are taking, including hormones, vitamins, herbs, and non-prescription medications.
7. Check any major illnesses you have experienced from the provided list. If you have had surgical procedures, detail them along with the date, reason, and hospital name in the surgical history section.
8. Review the current symptoms section and check all symptoms that apply to you. This helps the practitioner understand your health status better.
9. Provide any additional medical information that may be relevant for the practitioner to know.
10. Read the client consent information carefully. It is important that you understand the purpose of the massage and the conditions under which it might be contraindicated.
11. Sign and date the form at the bottom. If the form is for a minor, include the signature of a parent or guardian.
12. Once all sections of the form are completed, save any changes made, and you may have options to download, print, or share the completed document as needed.

Complete the AZ Martha Reamy Lymphatic Massage Client Intake Form online to ensure a smooth and efficient appointment.