Collective Bliss Health Intake

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Personal Info
Contact Info
Emergency Contact
Other
Medical Info
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Conditions
LU/LI (Metal)
TMJ (Jaw)
Feet
Health Questions
SP/ST (Earth)
Treatment Goals
Infectious
Emotion / Memory
LIV/GB (Wood)
Well Being
HT/SI (Fire)
Oncology
COVID-19 Questionnaire (Check Appropriate Boxes to Comment Below)
Area of Complaint
Headaches
Brain Disorders
Skin
Musculoskeletal
Endocrine
Neurological
Cardiovascular
Immune
General Injury Related Questions
Miscellaneous
Prenatal (check boxes to enter details below)
Massage Goals
Accident Info
Which best describes what you are experiencing
Current Complaint
Allergy