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SANDY
BELTRAMINI
ABOUT
SELFATIONSHIP
CONTACT
SANDY BELTRAMINI
New CLIENT HEALTH HISTORY
This information is critical to your massage treatment as it may affect the manner in which your therapist structures your session. All information disclosed will be kept strictly confidential.
Full Name
Today's Date
Email
Phone
Address
City
State
Zip Code
Occupation
Gender
Choose an option
Date of Birth
Have you ever had a therapeutic massage before?
Yes
No
If yes, approximately how many?
On a scale of 0 to 10, what is the amount of tension in your life? ( 0 = None 5 = Average 10 = Extreme )
What physical activities do you do on a daily or weekly basis?
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SELFATIONSHIP PROGRAM
LEARN MORE: KEYWORDS AND DETAILS
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