Massage Intake - Patient Information Form printable pdf download

Massage Intake - Patient Information Form

Massage Intake

Kwan-Yin Healing Arts Center

2330 NW Flanders, Suite 101

Portland, OR 97210

(503) 701-8766

Thank you for scheduling with us, we strive to provide

the best possible integrative care for our clients. Here at the clinic we have a team

of Naturopathic Doctors, Oriental Medical Practitioners, Licensed Acupuncturists,

Body Workers, Massage Therapists, Psychologists, Medical Doctors, Physical

Therapists and Chiropractic Physicians. During your initial evaluation your

practitioner will do their best to do a thorough evaluation and give you a

treatment plan. You can assist us in that by making sure you have fully completed

the intake paperwork enclosed. The advantage of the integrative office is that

there are many modalities that can provide input should any of us find the need

for assistance.

We are located just west of the intersection of NW 23

on NW Flanders (between

& 24

Ave.). Parking is available in the main and lower lot; please do not park

below the building in the covered area. Wheelchair access for the first floor is

located through the main level parking lot. Please come a few minutes early and

enjoy a cup of tea before your appointment.

Please be aware that we ask patients to give us 24 hour notice if they need to

reschedule or cancel an appointment. Late cancellation or missed appointments

incur a $45.00 fee or greater, as we are unable to reschedule the appointment

with another patient without sufficient notice.

It will be a pleasure to support you on your path towards wellness.

PATIENT NAME:__________________________________________________________

PATIENT DOB:____________________________

KWAN-YIN HEALING ARTS CENTER

2330 NW FLANDERS ST. SUITE 101

PORTLAND, OR 97210

PH: 503.701.8766

FAX: 503.241.5484

Massage Intake - Patient Information Form