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Shiatsu Health History Form

Please fill out our Shiatsu Health History Form before your initial Shiatsu Massage. It will help us identify how best to meet your specific needs.

The Shiatsu Health History Form can be downloaded with either Adobe Acrobat or MS Word. Click below to open, print, fill out and bring with you to your first appointment.

Health History Form – Adobe Acrobat Version
Health History Form – Microsoft Word Version



If you don’t have Adobe Acrobat, please click here to download from the Adobe site.




We look forward to serving you.

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