Reflexology Intake For m 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and date of birth in the designated fields. This information is crucial for your records.
3. Fill in your address, town/city, and postal code to ensure accurate communication.
4. Provide your phone numbers (home, mobile, work) and email address. The email will be used solely for clinic purposes.
5. Indicate how you heard about the clinic by selecting from the options provided.
6. Complete the health history section honestly, detailing any current or past medical conditions, medications, surgeries, or hospitalizations.
7. For women, indicate if you are pregnant and specify the trimester.
8. Add any additional comments or concerns regarding your health at the end of the form.
9. Finally, review all entered information for accuracy before signing and dating the form to consent to treatment.

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