Restorative Somatic Therapies
working out of Gaul Family Chiropractic
Client Forms

This is the form that all new clients must fill out.  This gives me your general contact info as well as basic medical info that directly relates to your massage. You are welcome to fill this out in advance and bring the completed version to your first appointment. (Note that this form does not need to be filled out for every appointment -- just for your first appointment, and then if your contact or other information changes):  Intake Form

This short form is to be completed just prior to your session.  It is most useful for clients with regular ongoing sessions including body-stored trauma release sessions, and in conjunction with the Post-Treatment Evaluation form, so that both you and I can gauge how the bodywork is progressing: Pre-Treatment Evaluation

This short form is to be completed after your session (between 36 - 72 hours post-treatment yields the best results).  It is most useful for clients with regular ongoing sessions including body-stored trauma release sessions,, and in conjunction with the Pre-Treatment Evaluation form, so that both you and I can gauge how the bodywork is progressing: Post-Treatment Evaluation

This form can be completed by any client - whether a one-time client or on-going client.  It gives me feedback so that I know how well I met your needs and so that I can address any issues that might have affected your session.  Client Feedback form

This form is to be completed by your physician (or other primary health care provider) if you are have a condition that might be considered a contraindication for massage therapy (i.e., for which massage therapy would be prohibited).  Conditions that meet this criteria include but are not limited to: recent surgery, hypertension, severe asthma, hemophilia, liver failure, and non-terminal but metastatic cancer.  If you have any condition that requires constant monitoring by a physician, please check with your health care provider and get permission from them to receive massage work.  Physician's Permission form

This form is to be completed by your physician (or other primary health care provider) if you are being referred to massage therapy from them: Physician's Referral form

This form must be filled out and signed by you (the client) if you would like me (the therapist) to share your massage therapy records with another health care provider.  Note that federal law (HIPPA) forbids the sharing of medical records with any individual or entity unless noted in writing through this form: HIPPA Release form

Who Should I See For Other Kinds of Treatment?


This is a list of other health care providers, all of whom have been recommended by individuals or organizations within the queer and/or transgender communities: For Other Health Care / Mental Health Needs, See These Practitioners

 

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