Confidential Intake Form - Massage
Current Medications and /or Supplements/Remedies: ... Hands or feet Asthma Neurological problems Cold Hands/feet Spinal Problems Swollen ankles Herniated/Bulging Discs Sinus Conditions Osteoarthritis Frequent Colds Arthritis Allergies (specify above) Anxiety Loss of smell/taste Depression/Panic Skin Conditions Sleep Disturbance Painful/Swollen ... ................
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