Please complete the health intake form prior to your first in person session.

Client Health Intake

Please share the following information about you & your health. Your information is confidential. Please Inform Stephanie of any changes in your health between now and your scheduled sessions.

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Are you currently suffering from a medical condition, communicable disease, illness, or injury? Have you been hospitalized in the last 12 months?
Have you had any past diagnosis of Covid?
Do you now, or have you recently had, any respiratory or flu symptoms, sore throat, or shortness of breath? Have you had any Covid Symptoms recently?
Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?

Successfully Submitted, Thank you.