Get the free Zen Shiatsu Therapy Intake Form - Mind Body and Flow

Zen Shiatsu Therapy Intake Form (All information is kept strictly confidential) Name Date / / Date of Birth / / Age Height Weight Home Address Zip City: State Zip Current Employer Job Title Employer

How to fill out zen shiatsu therapy intake

How to fill out Zen Shiatsu therapy intake:

1. Start by providing your personal information such as your name, address, phone number, and email address. This is important for the therapist to have your contact details in case of any updates or emergencies.
2. Next, provide your date of birth and gender. This information can be relevant for the therapist to better understand your specific needs and preferences.
3. Write down any existing medical conditions or ailments that you are currently experiencing. This includes chronic illnesses, injuries, or any recent surgeries. It is important to be honest and thorough in this section as it will help the therapist tailor the treatment according to your condition.
4. Mention any medications or supplements you are currently taking. This includes both prescription and over-the-counter medications. It is crucial for the therapist to be aware of any potential contraindications or interactions that may affect the treatment.
5. Indicate any allergies or sensitivities you have. This includes allergies to certain medications, ingredients, or materials used in the therapy. This information will help the therapist ensure that the treatment is safe and suitable for you.
6. Describe your current lifestyle and daily routine. This includes your occupation, physical activities, stress levels, and sleep patterns. The therapist may consider these factors to provide you with advice on maintaining a balanced lifestyle and reducing stress.
7. Mention any specific goals or expectations you have for the therapy session. This could be relieving pain, reducing stress, improving flexibility, or enhancing overall well-being. This will help the therapist understand your desired outcomes and tailor the treatment accordingly.
8. Provide any additional information or concerns you may have. This could include fears, anxieties, or past experiences that you believe may impact the therapy session. It is important to communicate openly with the therapist to ensure a safe and comfortable treatment experience.
9. Finally, sign and date the intake form to acknowledge that the information provided is accurate and complete.

Who needs Zen Shiatsu therapy intake?

1. Individuals who are seeking Zen Shiatsu therapy for the first time are required to fill out an intake form. This helps the therapist understand their medical history, lifestyle, and goals for the session.
2. People who have medical conditions or are currently taking medications should also complete a Zen Shiatsu therapy intake. This helps the therapist assess any potential contraindications or modifications that may be required during the session.
3. Anyone who wants to receive a tailored treatment based on their specific needs should fill out a Zen Shiatsu therapy intake. This allows the therapist to provide a personalized experience and address individual concerns.

For pdfFiller’s FAQs

What is zen shiatsu therapy intake?

Zen shiatsu therapy intake is a process of gathering information about the client's health history, current condition, and treatment goals in order to provide personalized shiatsu therapy sessions.

Who is required to file zen shiatsu therapy intake?

Clients who are seeking shiatsu therapy sessions are required to fill out the zen shiatsu therapy intake form.

How to fill out zen shiatsu therapy intake?

Clients can fill out the zen shiatsu therapy intake form either online or in person, providing details about their health history, current symptoms, and goals for treatment.

What is the purpose of zen shiatsu therapy intake?

The purpose of zen shiatsu therapy intake is to gather relevant information to tailor the shiatsu therapy sessions to the client's individual needs and to ensure a safe and effective treatment plan.

What information must be reported on zen shiatsu therapy intake?

Information such as medical history, current symptoms, previous injuries, and treatment goals must be reported on the zen shiatsu therapy intake form.

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