Michelle Heinz, LMT
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Emotion / Memory
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Location
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Status
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Treatment: Surgery
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Date of Surgery
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Lymph Nodes Removed
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Treatment: Chemotherapy
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Treatment: Radiation
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Area of Complaint
Left Side of Neck
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Right Side of Neck
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Right Foot
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Cardiovascular
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Blood Pressure
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Phlebitis
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Hyperthyroidism
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Hypothyroidism
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Musculoskeletal
Compartment Syndrome
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Psoriatic Arthritis
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Sinus Problems
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Fibromyalgia
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Plantar Fasciitis
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Artificial Joints / Special Equipment
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Scleroderma
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Arthritis
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Spondylolisthesis
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Joint Injury
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Amyotrophic Lateral Sclerosis (ALS)
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Ehlers-Danlos Syndrome
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Osgood-Schlatter Disease
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Carpal Tunnel Syndrome
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Ankylosing Spondylitis
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Bone Disease
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Osteoporosis
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Skin
Plantar's Wart
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Allergic Dermatosis
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Melanoma
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Celiac Disease
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Irritable Bowel Syndrome
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Mental Health Issues
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Prenatal (check boxes to enter details below)
Due Date
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Blood Clot (Phlebitis)
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Leg Cramps
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Nausea
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Pre-eclampsia (toxemia)
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Sciatica
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Previous C-Section
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High Risk Pregnancy
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Massage Goals
Stress Relief
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Alternative Therapy
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Positive Reinforcement
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Increase Well-Being
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