Please fill out the form below before your first treatment. Any questions, please contact me.
The information request below will assist in treating you safely. It is your right to ask any questions about the information being requested. Please note that all information provided below will be kept confidentially unless allowed or required by law. Your written permission will be required to release any information. The following information will be used to help plan safe and effective treatment sessions. Please answer the questions to the best of your knowledge.
