Chi-link Natural Therapy Health Centre | Massage in Brisbane | Massage Therapy Brisbane | Sydney Massage

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Please answer the following questionnaire:
Question 1. Have you had the following case history? Please tick box and any relevant information that may apply to you.
	Fractures
	Spinal Injuries
	Joint Dislocation
	Spinal Disorders
	High/Low Blood Pressure
	Diabetes
	Cardiac Problems
	None of Above
	Pregnant Weeks
Question 2. Past History (Previous ailments and surgery)?
Question 3. What is your main health concern/complaint?
Question 4. Have you had any accidents in the last 5 years?	if yes please specify:
Question 5. Do you have any chronic illness?	if yes please specify:
Question 6. Do you currently have any contagious disease?	if yes please specify:
Question 7. Do you have any allergies?	if yes please specify:
Question 8. Do you have a weak appetite or lack of thirst?
Question 9. Duration of current symptoms? How did the symptoms develop?
Question 10. Addictions?
Question 11. Any known cause to you for the disease?
Question 12. State of digestion, micturition, appetite and sleep:?
Question 13. Treatments to date?
Question 14. Recent investigations reports (blood, urine, stool, x-ray, CT scan etc:) ?
Question 15 Your individual problems:
Which branch you are most close to:
How did you hear about us?:
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