Helpful Forms

The following forms are designed to help us work together more easily.

All clients must wear a well-fitted KN95 or N95 mask regardless of vaccination status.  I can provide you with a KN95 mask. I wear an N95 mask.

Confidential Client Questionnaire

Confidential Medical Questions

Ashiatsu Disclaimer with Follow up care

Read and sign this form, and bring it to your first Ashiatsu session.

Prescription Form

Prescription form to be signed by your doctor

Note: To download Adobe Acrobat Reader for free, click here.