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Area of Complaint
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Left Side of Neck
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Right Knee
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Vertebral and Spinal Cord Injury
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Cardiovascular
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Artificial Joints / Special Equipment
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Ehlers-Danlos Syndrome
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Skin
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Rash
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Allergic Dermatosis
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Rosacea
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Athletes Foot
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UV Burn
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Bruise Easily
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Chemical Burn
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Skin Conditions
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Infectious Skin Conditions
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Eczema
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Hypersensitive Reactions
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Herpes
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Motion Sickness
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Tinnitus
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Conductive Hearing Loss
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Immune
Allergies
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Cancer
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Lupus
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Hodgkin Lymphoma
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Infectious Mononucleosis
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Leukemia
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Rheumatoid Arthritis
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Anaphylaxis
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Non-Hodgkin Lymphoma
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Other Immune
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Blood
Blood Thinner Medication
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Fainting Spells
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Stroke
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Other Blood
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Family History
Arthritis
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Cardiovascular
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Respiratory
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General Injury Related Questions
Previous sports-related injuries?
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Treatment of previous injury?
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Physical Therapy
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Chiropractic
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OTC medications
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Pain medications or steroids
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Surgery (type/year)
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Complications from that injury?
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Miscellaneous
Vision Loss
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Insomnia
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Surgical Pins or Wire
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Vision Problems
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Other Diagnosed Diseases
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Massage Goals
Strength Training
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Alternative Therapy
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Balance
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Stress Relief
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Flexibility
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Improve Fitness
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Improve Symptoms
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Increase Well-Being
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Positive Reinforcement
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Injury Rehabilitation
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Pain Relief
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Address Health Issues
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Massage Frequency
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Light Pressure Preferred
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Medium Pressure Preferred
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Other
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Deep Pressure Preferred
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Physical Activities You Participate In
Yoga
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Basketball
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Running
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Crossfit
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Soccer
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Football
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Softball
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Golf
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Swimming
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Lacrosse
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Tennis
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Triathlon
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Marathon
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Waterpolo
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Pilates
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Weight Lifting
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Baseball
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Rugby
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Other Activities
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Allergy
Coconut Oil
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Environmental
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Latex
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Sensitive to scents/essential oils
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Other Allergies
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