FST Health History

Name(Required)
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Please check all that apply and explain on back if necessary:
The above information is accurate and true to the best of my knowledge. If there are any changes in my current level of health, I will inform the practitioner of my condition. I understand that this practitioner does not diagnose or treat illness or disease and does not prescribe medications. I understand that close contact with people increases the risk of infection from Covid-19. I acknowledge that I am aware of the risks involved and give consent to receive Fascial Stretch Therapy from this practitioner. It is agreed that any claim of liability is hereby waived.
This field is for validation purposes and should be left unchanged.