PathFinder Client Information

Date
Name Street Address

City    State   

Zip Code

Phones
Home:   
Work:   Cell:

Email Address

Birth Date
  Age

Occupation

How did you hear about PathFinder?

Please check any of the following
that apply to you:
Taking prescription medication
Using
non-prescription vitamins, supplements, herbs, etc.
Serious
illnesses, surgery or trauma now or in the past
Recovering
from recent surgery, fracture or serious illness
Currently
have infection or wound

List anything else you think I should
know that might effect your ability to lie down, relax, or receive a
light touch to the body.

Issues or concerns you would like
to have addressed
(i.e. what you would like to accomplish from
your session/s)

May I call or email you after a
session to ask how you are doing?
Yes
No