Suzanne's Foot Reflexology Care

HEALTH HISTORY FORM

An accurate health history is important to ensure that it is safe for you to receive a Foot, Facial Reflexology, Indian Head massage, Therapeutic Touch and Emotion Code. All information gathered for treatments mentioned above is confidential except as required by law. Written authorization will be required for release of any information.

If having trouble with the form above, you can download and email to suzanne@reflexologycare.com