Island Healing Medical Intake Form
This heath questionnaire is required before visiting Island Healing. Kindly complete two days before your scheduled appointment time.
  • - -
  • Please provide as much detail of your current and historical medical conditions.

  • Note any reaction to essential oils, powders or lotions.
  • Fever, chills, cough, shortness of breath, sore throat, painful swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue, or loss of appetite.
  • >You understand that Island Healing is providing massage therapy services within their scope of business practices defined by British Columbia.

    > You understand that massage therapy is not a replacement for any medical examination, and my practice at Island Healing is never considered a ‘visit’ to a doctor.

    > You understand that Island Healing must be aware of any existing medical conditions prior to the massage therapy treatment, and you agree to inform the practitioner of any new conditions that may arise in the future.

    > You agree that Island Healing will not be responsible or liable of any COVID-19 related injuries, illnesses, or death as a result of this from any massage therapy treatments.

    > By submitting this form "you the client" state that the above information provided is accurate to the best of your knowledge and that this information will be kept confidential.
  • / /