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Intake form

If you have been diagnosed with blood clots, severe swelling, infection, or other medical conditions affecting the feet or circulation, please consult your healthcare provider before receiving a treatment.

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 and Craniosacral Fascial Therapy are natural, non-invasive therapies intended to promote relaxation, support stress reduction, and encourage the body’s own healing processes.

I acknowledge that the practitioner does not diagnose illness, medical conditions, or disorders, and does not prescribe medical treatments or perform medical procedures.

I understand that these therapies are not a substitute for medical care and are intended to be used as complementary approaches to overall wellness.

I agree to inform the practitioner of my current health status and any changes in my condition at the time of each visit.

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