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Client Intake Form

Have you had Reflexology before?
Are you receiving any other natural or medical therapies?
Are you on any medication?
Please check off any conditions you currently have.

I understand that Reflexology is a natural, non-invasive technique intended to promote relaxation, support stress reduction, and encourage the body's own healing process. I acknowledge that a Reflexologist does not diagnose illness, medical conditions or disorders and does not prescribe medical treatments or perform medical procedures. I understand that Reflexology is not a substitute for medical care and should be used as a complimentary approach. I will inform the Reflexologist of my current health status and any changes in my condition at the time of each visit.

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