Get Wi Madison Lymphatics & Bodywork Manual Lymphatic Drainage Intake Form 2017-2025

Completing the WI Madison Lymphatics & Bodywork Manual Lymphatic Drainage Intake Form is an important step in preparing for your session. This guide will provide you with clear instructions on how to effectively fill out the form online, ensuring that you provide all necessary information for your personalized care.

Follow the steps to accurately complete your intake form.

1. Press the ‘Get Form’ button to access the intake form online and open it in your preferred editor.
2. Enter the current date in the designated field, ensuring accuracy as this is essential for your appointment record.
3. Fill in your full name as you would like it to appear in the clinic’s records.
4. Provide your birth date in the specified format to ensure compliance with health regulations.
5. Complete your address details, including street, city, state, and zip code, for communication purposes.
6. List your contact number and email address to ensure the clinic can reach you for any necessary follow-ups.
7. In the emergency contact section, record a name and phone number of someone who can be reached if needed while you are at the clinic.
8. Fill in the name of your primary care physician and their clinic to facilitate communication regarding your health if necessary.
9. Indicate the reason for seeking manual lymphatic drainage by marking the appropriate option.
10. If your visit is related to a medical issue, specify when the problem began and describe the issue in detail, including its location and severity.
11. Circle all affected areas from the provided list to help the practitioner understand your needs.
12. Mark any current or previous conditions that are relevant to your treatment to provide a comprehensive view of your health history.
13. List any past surgeries, including dates and facilities, to inform your therapist of your medical background.
14. Document all medications you are currently taking, including their purposes, to ensure safety during your treatment.
15. Share any additional information that your therapist should be aware of to tailor your session effectively.
16. Read and understand the consent information regarding the treatment, then provide your signature and date to confirm your agreement.
17. If you are consenting for a minor, provide the signature of the parent or guardian along with the date.
18. Once all fields are complete, save your changes and choose to download, print, or share the form as needed for your records.

Begin filling out your intake form online today to prepare for a successful session.