New Patient Forms
Basic Information Form
Dr. Erica Chao
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Begin Your Healing
Massage Initial Intake
What are your health concerns and goals?
Vitamins/Supplements and reason for taking:
Medications and reason for taking:
Do you have a pacemaker?
Are you currently Pregnant or attempting to become Pregnant?
Do you suffer from any chronic pain? If yes, Please describe this pain.
Is there anything that aggravates or alleviates your discomfort?
Check all that apply to you:
High/Low Blood Pressure
Sprains or Strains
Hot or Cold easily
I have answered truthfully and to the best of my knowledge
Submit and Sign Consent Form