lymph intake form

If you are booking lymphatic drainage please complete:

* Indicates required field

Name *

Phone Number *

What is the reason you are seeking lymphatic drainage? *

Have you ever received lymphatic drainage? *

yes no I don't know

Have you been cleared by your doctor? *

Do you have any position restrictions? *

What treatments/surgeries have you undergone (if any) and when? *

Other, please list: *

Anything else you would like your therapist to know before you come in? *

Submit