Understandably, many people are hesitant to share personal information, but as with any other health care provider, any information you provide on this intake form is strictly confidential. It is necessary to fill out a health history form because it allows me to provide a massage that is medically safe as there are health issues that are contraindicted to massage or require me to proceed with caution. I am also required by my licensing board, NCBTMB and my professional association, the AMTA to take a health history before giving massage.
Terye Wohnus, Nationally Certified Massage Therapist
Centered Healing Therapeutic Massage200 Clark Avenue, Brattleboro, VT 05301 802-251-0015 www.CenteredHealingVT.com
This form allows me to assess your needs and establish your treatment plan.
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