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CONFIDENTIAL PATIENT HISTORY FORM Delbrook Massage Therapy Clinic 100-3711 Dlebrook Avenue North Vancouver BC V7N 3Z4 604. Joint Dislocation Bone Fracture Arthritis Osteoporosis Rods / Pins / Plates / Shunts Implants Transplant Corrective Lenses/Contacts Cancer Hepatitis HIV other Contagious condition Please list any Medications you presently take Known Allergies including medications foods seasonal oils and lotions etc. Do you have any family history of medical conditions Yes No Please list...

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