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Client Information for Bodycentric Healing Arts
Thank you for filling out this Client Information Form prior to your first appointment. This will be used as a guide when we discuss your treatment plan. Please be sure to check a few required boxes before submitting your form. If you have any questions, please don't hesitate to call us: 610.200.8008 We look forward to working with you. The Bodycentric Staff
Chiropractor, Physical Therapist, Acupuncturist, Nutritionist, Bodyworker, Other
Please check any of the conditions that you are currently experiencing or have recently experienced.
Please check any of the conditions that you are currently experiencing or have recently experienced.
Please check any of the conditions that you are currently experiencing or have recently experienced.
Please check any of the conditions that you are currently experiencing or have recently experienced.
Checking the box is required.
ETHICS: We provide services within the scope of A.B.M.P. definition of massage, bodywork, somatic therapies, and the boundaries of our training. We will not employ those techniques for which we have not had adequate training and shall represent our education, training, qualifications, and abilities honestly.

Behavior of a sexual nature will not be tolerated. Any implication, remarks, or advances will result in termination of the session. Payment for the scheduled appointment will be expected.

What is the fourth letter of the alphabet?

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