This is my generic consultation, what do you think?

[terrimouse]

Hi Geeks below is a copy of my generic consultation, i have individual ones for each treatment i do but most of my clients come for a bit of everything if you know what i mean. I am always tinkering with my consultation forms but i just wondered what you thought of this generic one, a bit of a one for all. Have i missed anything?
Many thanks
xxx

(feel free to use mine too if you are struggling with yours)

ps this all fits nicely on an a4 form with 2 neat colums, hasn't quite come out well on here lol



Please can you look at each of these conditions and Tick any that apply to you
[FONT=Times New Roman,Bold, sans-serif]The information given will be treated as private and confidential and will not be revealed to any third party without your prior authorisation[/FONT]
[FONT=Times New Roman,Bold, sans-serif]This information is asked in order to provide the correct and necessary treatment[/FONT]
[FONT=Times New Roman, serif]Are you on any medication[/FONT]
[FONT=Times New Roman, serif]Do you have any allergies[/FONT]
[FONT=Times New Roman, serif]Severe bruising on an area to be treated[/FONT]
[FONT=Times New Roman, serif]Epilepsy[/FONT]
[FONT=Times New Roman, serif]Recent haemorrhage[/FONT]
[FONT=Times New Roman, serif]High or low blood pressure[/FONT]
[FONT=Times New Roman, serif]Poor Circulation[/FONT]
[FONT=Times New Roman, serif]Migraines or headaches[/FONT]
[FONT=Times New Roman, serif]Thrombosis or embolism or History of[/FONT]
[FONT=Times New Roman, serif]Heart Conditions[/FONT]
[FONT=Times New Roman, serif]High Cholesterol[/FONT]
[FONT=Times New Roman, serif]Varicose Veins[/FONT]
[FONT=Times New Roman, serif]Respiratory Problems[/FONT]
[FONT=Times New Roman, serif]Cancer[/FONT]
[FONT=Times New Roman, serif]Diabetes[/FONT]
[FONT=Times New Roman, serif]Arthritis[/FONT]
[FONT=Times New Roman, serif]Rheumatism[/FONT]
[FONT=Times New Roman, serif]Muscle spasms[/FONT]
[FONT=Times New Roman, serif]Dysfunction of the nervous system (e.g. Multiple Sclerosis)[/FONT]
[FONT=Times New Roman, serif]Skin disorders (e.g. eczema, psoriasis[/FONT]
[FONT=Times New Roman, serif]Bacterial, Viral, Fungal or Infestation Infections (e.g. impetigo, herpes, HIV, AIDS, Candidiasis, Scabies)[/FONT]


[FONT=Times New Roman, serif]Cuts or abrasions [/FONT]
[FONT=Times New Roman, serif]Any recent injury[/FONT]
[FONT=Times New Roman, serif]A recent operation[/FONT]
[FONT=Times New Roman, serif]Are you pregnant[/FONT]
[FONT=Times New Roman, serif]Recently Pregnant[/FONT]
[FONT=Times New Roman, serif]Menstruating[/FONT]
[FONT=Times New Roman, serif]Menstruation Problems[/FONT]
[FONT=Times New Roman, serif]Infertility[/FONT]
[FONT=Times New Roman, serif]Thyroid[/FONT]
[FONT=Times New Roman, serif]Digestive problems[/FONT]
[FONT=Times New Roman, serif]Kidney/bladder problems[/FONT]
[FONT=Times New Roman, serif]Insomnia[/FONT]
[FONT=Times New Roman, serif]Hormonal Problems[/FONT]
[FONT=Times New Roman, serif]Migraine/Headaches[/FONT]
[FONT=Times New Roman, serif]Eye Problems[/FONT]
[FONT=Times New Roman, serif]Contact Lenses[/FONT]
[FONT=Times New Roman, serif]Fluid Retention[/FONT]
[FONT=Times New Roman, serif]Backache[/FONT]
[FONT=Times New Roman, serif]Depression[/FONT]
[FONT=Times New Roman, serif]Emotional Problems[/FONT]
[FONT=Times New Roman, serif]Stress[/FONT]
[FONT=Times New Roman, serif]Other pain[/FONT]


[FONT=Times New Roman, serif]Details:[/FONT]








CLIENT DECLARATION:
The information I have given regarding my medical details is accurate.
I will promptly notify the therapist of any future changes to my health.
Signed: Date: Name & Address:
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[terrimouse]

:biggrin:
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