Get Now And Zen Manual Lymphatic Drainage Therapy Intake Form 2018-2025

Filling out the Now And Zen Manual Lymphatic Drainage Therapy Intake Form online is a straightforward process that ensures you provide essential information for your therapy session. This guide will walk you through each section, helping you understand what information is needed and how to complete it effectively.

Follow the steps to complete the intake form accurately.

1. Press the ‘Get Form’ button to access the intake form and open it in your preferred editor.
2. Begin by entering today’s date in the designated field. This helps maintain accurate records for your therapy session.
3. Provide your full name and birth date. This information is crucial for identification and medical history tracking.
4. Complete your address, phone number, and email address. This information is used for contact purposes and appointment scheduling.
5. In the ‘In Case of Emergency’ section, list a contact person and their phone number. This ensures that someone can be reached if necessary.
6. Fill in the name of your primary care physician and the person or service that referred you. This helps keep your health care providers informed.
7. Indicate why you are seeking Manual Lymphatic Drainage by checking either the ‘Therapeutic’ or ‘Medical Issue’ box. If it is a medical issue, please specify when the problem started.
8. Describe the problem you are experiencing, including its location and severity. Provide as much detail as you feel comfortable sharing.
9. If applicable, indicate whether you are currently undergoing cancer treatments and include the date of your last chemotherapy treatment.
10. In the Personal Past History of Illnesses section, mark ‘Yes’ or ‘No’ for each listed illness. This information helps the practitioner understand your medical background.
11. List any current medications you are taking, including supplements and nonprescription drugs, to ensure the practitioner is aware of all substances affecting your health.
12. Detail any surgical history, including the type of operation, hospital name, and date performed. This provides context for your current health status.
13. Complete the Review of Current Symptoms section by marking any relevant symptoms you are currently experiencing. This helps in evaluating your condition.
14. Include any additional medical or personal information that may be pertinent for the practitioner’s awareness.
15. Read and understand the consent statement regarding the nature of Manual Lymphatic Drainage therapy. Sign and date the form to confirm your understanding and consent.
16. Finally, if applicable, have a parent or guardian sign the consent to treatment of a minor section, and provide the date.
17. After completing the form, you can save changes, download, print, or share the form for your records.

Complete the Now And Zen Manual Lymphatic Drainage Therapy Intake Form online to ensure a smooth and informed therapy session.