Holistic Massage Diploma Assessment Book

Size: px
Start display at page:

Download "Holistic Massage Diploma Assessment Book"

Transcription

1 Holistic Massage Diploma Assessment Book #

2 Contents Contents... 2 Study Tips & Suggestions... 3 Assessment Questions... 5 The Application of Massage... 5 Contraindications & Cautions... 7 The Need for Referral... 7 Client Management... 7 Clinical Practice... 7 Congratulations! Essentially Holistic / Fleur Aromatherapy 2

3 Study Tips & Suggestions You can study the modules at your own pace, depending on your commitments and lifestyle. There is an assessment for every lesson which is assessed by your personal tutor. Your tutor will mark your work give you feedback, hints and tips along with suggestions for further reading and research. It is advisable to read through the module several times before completing the test paper. We recommend you create a realistic study timetable and then stick to it. Ideally, study periods should be of equal length. Remember that learning is a process which involves several stages of acquiring knowledge. The following recommendations should make the process easier for you. Study in a pleasant environment research shows that you will learn better when relaxed. Experiment do you learn better when listening to music, when moving around, sitting in bed? Concentration try setting a timer to go off after 15 minutes, then forget about it and concentrate on your studies. If your concentration wanders before the alarm goes off, set the timer for 10 minutes. If you can concentrate for 15 minutes, increase the time to 20 minutes. Take a break and walk around after an hour of study Essentially Holistic / Fleur Aromatherapy 3

4 Acquiring new vocabulary I suggest you buy a good dictionary and look up new words; don t guess at the meaning. On-line study can be isolating, so do take advantage of the student forum to make contact with fellow students During the course you will be required to complete and submit a number of case studies, full details of how this is done is included in the course material. So now is the time to start enlisting people to be subjects for your practical studies. When answering the questions make sure that you have covered all the necessary points. Please use diagrams to help illustrate your answers whenever possible (you do not have to be a great artist!) Good luck with your studies Essentially Holistic / Fleur Aromatherapy 4

5 Assessment Questions The Application of Massage Examine and critically appraise the application of massage for specific conditions listed below (Choose one from each body system) words for each condition Integumentary system Eczema Psoriasis Acne General allergies Dermatitis Skeletal System Osteoarthritis Rheumatoid arthritis Tendonitis Sprains & strains Synovitis Non-specific back pain The Muscular System Fibrositis Fibromyalgia Repetitive strain injury Carpel tunnel syndrome Chronic fatigue syndrome (ME) The Nervous system Post Natal Depression Seasonal Affective Disorder Clinical Depression Bell s Palsy Trigeminal neuralgia Cerebral Palsy The Endocrine System Hyperthyroidism Hypothyroidism Diabetes mellitus (type I & II) 2013 Essentially Holistic / Fleur Aromatherapy

6 The Cardiovascular System Haematoma Glandular fever Haemorrhoids Varicose Veins Raynauds syndrome The Lymphatic System Oedema Enlarged Lymph Nodes Lymphoedema Tonsillitis The Immune System Allergies Immunodeficiency diseases e.g. Aids Chronic fatigue syndrome The Respiratory System Chronic obstructive pulmonary disease (COPD) Asthma Bronchitis Emphysema Seasonal rhinitis (hayfever) Sinusitis Common cold Influenza The Digestive System Irritable bowel syndrome Crohn s Disease Coeliac disease Diarrhoea & constipation Anorexia Nervosa Bulimia Obesity The Urinary System Inflammatory disorders e.g. urinary tract infections, cystitis, Effects of poor and ineffective elimination Urinary incontinence Bed wetting 2013 Essentially Holistic / Fleur Aromatherapy 6

7 The Reproductive System Endometriosis, Infertility, Premenstrual tension Dysmenorrhoea, Amenorrhoea, Post-natal depression Candida albicans Vaginitis Impotence Frigidity Contraindications & Cautions Identify from the list above, the conditions, both local and general, which would require caution when offering massage and state the reasons for caution, along with possible action, including conditions with which the practitioner is unfamiliar with or not confident to treat (Total words) The Need for Referral Identify 2 situations which might necessitate referral to other practitioners and demonstrate an understanding of the process of referral, and the roles of other practitioners. (Total words) Client Management Explain the requirement for professionalism ( words) Explore the maintenance of professional boundaries ( words) Clinical Practice Compile a consultation sheet / record card and justify the items included Essentially Holistic / Fleur Aromatherapy 7

8 Congratulations! You ve now finished the Theory element of the Holistic Massage Diploma Give yourself a reward You ve worked really hard Essentially Holistic / Fleur Aromatherapy 8

EVIDENCE-BASED VITAMIN AND MINERAL USAGE SUMMARY TABLE (APRIL 2002)

EVIDENCE-BASED VITAMIN AND MINERAL USAGE SUMMARY TABLE (APRIL 2002) Acne Acrodermatitis Enteropathica Adrenal Support Age Related Cognitive Decline Alcoholism/Alcohol Withdrawal Alzheimer's Disease Amenorrhoea Anaemia Angina Anorexia Nervosa Anxiety Asthma Atherosclerosis

More information

Natural Balance strives to offer efficacious, holistic, natural health-care, in a personalized, caring and supportive manner.

Natural Balance strives to offer efficacious, holistic, natural health-care, in a personalized, caring and supportive manner. - What do you do at Natural Balance? - What do you treat? - Do you treat children? - Why use a Herbalist? - How fast do these remedies take to work? - Can I take these remedies with these pharmaceutical

More information

Measuring Long-Term Conditions in Scotland - A summary report

Measuring Long-Term Conditions in Scotland - A summary report Measuring Long-Term Conditions in Scotland - A summary report Introduction This summary report provides insight into: What are the most common long-term conditions in Scotland? What is the population prevalence

More information

Aromatherapist: CLIENT RECORD. Personal Information: Name: D.O.B Occupation: Address: Telephone: Marital Status: Dependents: Doctor: Doctor Informed?

Aromatherapist: CLIENT RECORD. Personal Information: Name: D.O.B Occupation: Address: Telephone: Marital Status: Dependents: Doctor: Doctor Informed? CLIENT RECORD Personal Information: Name: D.O.B Occupation: Address: Telephone: Marital Status: Dependents: Doctor: Doctor Informed? Medical History: What are you doing for your health:(eg Exercise, Diet,

More information

Luck has nothing to do with it. Complementary & Alternative Medicine Guide

Luck has nothing to do with it. Complementary & Alternative Medicine Guide Luck has nothing to do with it. Complementary & Alternative Medicine Guide 5584 MS-02-616 2003 Oxford Health Plans, Inc. You say tomato. I say tomato. Oxford recognizes the obvious fact that people are

More information

Medical History Form

Medical History Form Medical History Form Full Name Title: Mr/Mrs/Ms/Miss Address Date of Birth Date Telephone: Mobile: Email: How did you hear about the Garden of health? G.P s Name and Address Are you currently seeing your

More information

Clinical Herbal Medicine

Clinical Herbal Medicine SUBJECT OUTLINE Subject Name: Clinical Herbal Medicine SECTION 1 GENERAL INFORMATION Subject Code: WHMC311 Award/s: Total course credit points: Level: Bachelor of Health Science (Naturopathy) 128 3 rd

More information

How much do you know about illnesses or health problems for your parents, grandparents, brothers, sisters, and/or children? 1 A lot Some None at all

How much do you know about illnesses or health problems for your parents, grandparents, brothers, sisters, and/or children? 1 A lot Some None at all Family Health History Please answer each question as honestly as possible. There are no right or wrong answers to nay of the questions. It is important that you answer as many questions as you can. We

More information

intake form About You : General Health Information: Page 1`of 5 State/Province: Country: Zip/Postal Code: Address:

intake form About You : General Health Information: Page 1`of 5 State/Province: Country: Zip/Postal Code:  Address: intake form Page 1`of 5 About You : Name: Sex: Male Female Address: City: State/Province: Country: Zip/Postal Code: Home Phone Number: Mobile Phone Number: Email Address: Birthday: Marital Status: Married

More information

CompassionMassage.com. Client Intake Form

CompassionMassage.com. Client Intake Form Name: Phone: ( CompassionMassage.com Client Intake Form ) E-Mail: Address: _ City: State: Zip: Date of Birth: Occupation: Referred by: In case of emergency: Phone: ( Chiropractor: ) General & Medical Information:

More information

Clinical Nutritional Medicine

Clinical Nutritional Medicine SUBJECT OUTLINE Subject Name: Clinical Nutritional Medicine SECTION 1 GENERAL INFORMATION Subject Code: NMDC221 Award/s: Total course credit points: Level: Bachelor of Health Science (Naturopathy) 128

More information

Cardiovascular Consent Form

Cardiovascular Consent Form Cardiovascular Consent Form Dear Primary Care Provider, A patient currently under your care for a cardiovascular condition has come to the Kingsbury Club Therapy Center to receive a therapeutic massage.

More information

MASSAGE I TAKE FORM RAQUEL CARTER LICE SED MASSAGE THERAPIST EXERCISE PHYSIOLOGIST REFLEXOLOGIST

MASSAGE I TAKE FORM RAQUEL CARTER LICE SED MASSAGE THERAPIST EXERCISE PHYSIOLOGIST REFLEXOLOGIST MASSAGE I TAKE FORM RAQUEL CARTER LICE SED MASSAGE THERAPIST EXERCISE PHYSIOLOGIST REFLEXOLOGIST CLIE T I FORMATIO NAME: DATE: Last First Middle Initial BIRTHDAY: MARITAL STATUS: S M W D DP ADDRESS: Street

More information

Colon Hydrotherapy Questionnaire

Colon Hydrotherapy Questionnaire Colon Hydrotherapy Questionnaire Full Name: Address: Telephone: Occupation: How did you hear about us? Email: Date of Birth: Please list any conditions for which you are currently being treated: Women

More information

REFLEXOLOGY HEALTH RECORD

REFLEXOLOGY HEALTH RECORD REFLEXOLOGY HEALTH RECORD THIS FORM IS TO BE COMPLETED BY THE CLIENT FIRST THEN BY PRACTITIONER FOR INITIAL SESSION Client Date of Birth Telephone Home Business Ext Email Address Street # City Street Name

More information

E DISCORSO INDIRETTO (DIRECT SPEECH AND REPORTED SPEECH)

E DISCORSO INDIRETTO (DIRECT SPEECH AND REPORTED SPEECH) Preface Grammar focus GRAMMAR INITIAL TEST PLURALE (PLURAL) ARTICOLO DETERMINATIVO (DEFINITE ARTICLE) ARTICOLO INDETERMINATIVO (INDEFINITE ARTICLE) 0 AGGETTIVI E PRONOMI INDEFINITI (INDEFINITIVE ADJECTIVES

More information

Living Life with Persistent Pain. A guide to improving your quality of life, in spite of pain

Living Life with Persistent Pain. A guide to improving your quality of life, in spite of pain Living Life with Persistent Pain A guide to improving your quality of life, in spite of pain Contents What is Persistent Pain? 1 The Science Bit 2 Pain & Stress 3 Coping with Stress 4 The importance of

More information

Pharmacy Prep. Qualifying Pharmacy Review

Pharmacy Prep. Qualifying Pharmacy Review Pharmacy Prep 2014 Misbah Biabani, Ph.D Director, Tips Review Centres 5460 Yonge St. Suites 209 & 210 Toronto ON M2N 6K7, Canada Luay Petros, R.Ph Pharmacy Manager, Wal-Mart, Canada 1 Disclaimer Your use

More information

Alivia Acupuncture Clinic, LLC. Address. City State Zip. . Occupation Employer. Emergency contact Relationship. Primary Care provider Phone

Alivia Acupuncture Clinic, LLC. Address. City State Zip.  . Occupation Employer. Emergency contact Relationship. Primary Care provider Phone Alivia Acupuncture Clinic, LLC Karla Sourasky Olmos, L. Ac Patient Information Name Age Date of birth Address City State Zip Email Home Phone Work phone Cell Phone Marital Status Single Married Divorced

More information

Ok, here s the deal. My name is Mel, but my close friends call me Messy Mel. I think it s their way of showing respect.

Ok, here s the deal. My name is Mel, but my close friends call me Messy Mel. I think it s their way of showing respect. The next few pages feature detailed review sheets for your students to study key topics. Messy Mel will serve as the narrator and walk students through a wide variety of terms and concepts (with his special

More information

Focus On: Reducing Risks and Coping with Chronic Diseases and Conditions

Focus On: Reducing Risks and Coping with Chronic Diseases and Conditions Chapter 13A Lecture Focus On: Reducing Risks and Coping with Chronic Diseases and Conditions Chronic Obstructive Pulmonary Disease Chronic obstructive pulmonary disease (COPD) is the term used to describe

More information

ABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION. Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security #: - -

ABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION. Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security #: - - ABUNDANT HEALTH CHIROPRACTIC New Patient Form PERSONAL INFORMATION Name: Gender: M F Today's Date: / / Birth Date: / / Age: Social Security : - - Home Address: City, State, Zip: Home Phone: ( ) Work Phone:

More information

National Occupational Standards

National Occupational Standards What this unit is about This unit is about the skills involved in providing hot and cold stone therapy treatments. It covers both massage and the placing of stones on the head, face and body. The ability

More information

Houston Academy of Medicine-Texas Medical Center Library

Houston Academy of Medicine-Texas Medical Center Library Houston Academy of Medicine-Texas Medical Center Library Health Reference Center-Academic Article 5 of 7 Acupuncture: Review and Analysis of Reports on Controlled Clinical Trial, Annual 2002 p23 Diseases

More information

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP

Shiatsu Intake Form PURCHASED PRODUCT/SERVICE. Date of Birth Age Height Weight. Home Address City State ZIP Shiatsu Intake Form DATE PURCHASED PRODUCT/SERVICE FIRST NAME LAST NAME Date of Birth Age Height Weight Home Address City State ZIP Home Phone Cell Phone Email Name of Emergency Contact Would you like

More information

HEALTH QUESTIONNAIRE (In strictest confidence)

HEALTH QUESTIONNAIRE (In strictest confidence) 0115 882 0292 www.gedlingcolonics.co.uk jane@gedlingcolonics.co.uk HEALTH QUESTIONNAIRE (In strictest confidence) Please save this document, complete, save and return to us by email or post. Alternatively

More information

Medical History Form

Medical History Form General: Medical History Form 1. Chief Complaint: What are the main health concerns you wish to address? 2. Current and Past Treatment: Have you received treatment for these problems? Yes No, if yes, which:

More information

Sharon Lunn LCPH, MCPH, HMA, MARCH, RT Registered Homeopath & Colon Hydrotherapist Clinic at: Harold Wood, Essex

Sharon Lunn LCPH, MCPH, HMA, MARCH, RT Registered Homeopath & Colon Hydrotherapist Clinic at: Harold Wood, Essex Sharon Lunn LCPH, MCPH, HMA, MARCH, RT Registered Homeopath & Colon Hydrotherapist Clinic at: Harold Wood, Essex 07932 553334 www.sharonlunn.co.uk HEALTH QUESTIONNAIRE (In strictest confidence) Full name

More information

National Occupational Standards

National Occupational Standards What this unit is about This unit is about the skills involved in providing head and body massage treatments. It covers manual massage of the head and body, as well as mechanical body massage techniques.

More information

Carry out massage using pre-blended aromatherapy oils

Carry out massage using pre-blended aromatherapy oils Carry out massage using pre-blended aromatherapy oils K/600/7523 Learner name: Learner number: VTCT is the specialist awarding body for the Hairdressing, Beauty Therapy, Complementary Therapy and Sport

More information

Written by Alex Case for UsingEnglish.com

Written by Alex Case for UsingEnglish.com Health and Fitness Vocabulary- Ask and Tell Speaking Game Choose one of the lines below and ask a question about that thing and/ or using that word, e.g. a personal questions about headaches or an opinion

More information

Human Anatomy and Physiology Marieb 2016

Human Anatomy and Physiology Marieb 2016 A Correlation of Marieb 2016 To the for Science A Correlation of, Science, HUMAN ANATOMY AND PHYSIOLOGY From Molecules to Organisms: Structures and Processes 1. Develop and use models and appropriate SE:

More information

ADDITIONAL GEMS OF WISDOM TO HELP YOU OVERCOME CFIDS, CANDIDIASIS AND FIBROMYALGIA

ADDITIONAL GEMS OF WISDOM TO HELP YOU OVERCOME CFIDS, CANDIDIASIS AND FIBROMYALGIA October 7-8, 2005. Milwaukee, Wisconsin ADDITIONAL GEMS OF WISDOM TO HELP YOU OVERCOME CFIDS, CANDIDIASIS AND FIBROMYALGIA Luis Paez, M.D. CFIDS Severe fatigue Anxiety Brain fog and confusion Prolonged

More information

Dear Yoga Therapy Case Study Applicant,

Dear Yoga Therapy Case Study Applicant, Dear Yoga Therapy Case Study Applicant, Many thanks for your interest in our program. We will do our best to secure a spot for you in our on- going free Saturday Clinic. Our only request is your commitment

More information

BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY

BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY BACK TO BASICS HEALTH & NUTRITION COMPREHENSIVE HEALTH HISTORY Thank you for choosing Back To Basics Health & Nutrition to assist you with your natural health care. The ability to draw effective conclusions

More information

WELLNESS HISTORY. Patient s Name: Date

WELLNESS HISTORY. Patient s Name: Date u:\share\sr dr\wellness history1 08-08-13 1 WELLNESS HISTORY Patient s Name: Date 1) Have you ever been to Acupuncturist? Yes No If Yes: Currently In the past, When: Did it help? What treatment did you

More information

New Client Intake. First Name Last Name. Address. City State Zipcode Date of Birth. Home Phone Mobile Phone. Relationship to you Phone

New Client Intake. First Name Last Name. Address. City State Zipcode Date of Birth. Home Phone Mobile Phone. Relationship to you Phone 1 New Client Intake Address City State Zipcode Date of Birth Home Phone Mobile Phone Emergency Contact: Relationship to you Phone Please explain the pain you are experiencing and its origin story: https://docs.google.com/document/d/1q0tns8lwtefzbbj1n9jyt2onopvy2abs9s1ofr07zai/edit

More information

Treatment. Zinbryta (daclizumab)

Treatment. Zinbryta (daclizumab) Information for people living with multiple sclerosis Treatment What is Zinbryta and how does it work? How is Zinbryta administered? Before you take Zinbryta While you are taking Zinbryta What are the

More information

Dear Valued Patient, Thanks for allowing me to be a part of your healthcare team! Sincerely, Mary Mees, LAc, DAOM

Dear Valued Patient, Thanks for allowing me to be a part of your healthcare team! Sincerely, Mary Mees, LAc, DAOM Dear Valued Patient, Welcome to Integrated Acupuncture Services! I know that you have many choices when looking for a healthcare practitioner, and I am quite happy that you have chosen me. You can be sure

More information

WHAT IS NUTRITIONAL THERAPY?

WHAT IS NUTRITIONAL THERAPY? WHAT IS NUTRITIONAL THERAPY? Poor diet and inadequate nutrition are now recognised as some of the primary causes of poor health for many people in our modern society. An increased reliance on processed

More information

Madison County Schools Human A & P Pacing Guide Unit topic Objective covered Time length

Madison County Schools Human A & P Pacing Guide Unit topic Objective covered Time length Madison County Schools Human A & P Pacing Guide Unit topic Objective covered Time length 1 st Nine Weeks Physiological Functions/Anatomical Structure -Terminology -Location of Cavities and Systems Cells

More information

What do you believe is causing your most important health concern?

What do you believe is causing your most important health concern? Intake form Name Today s Date Date of Birth Address City Phone Postal Code Email Primary Health Care Provider Emergency Contact Phone Note: By providing your email address you are giving us consent to

More information

Personal Information. Client Questionnaire. Basic Information. Date of Birth. Male Female Other Not Specified. Contact Information

Personal Information. Client Questionnaire. Basic Information. Date of Birth. Male Female Other Not Specified. Contact Information Client Questionnaire Personal Information Basic Information First Name Last Name Date of Birth Male Female Other Not Specified Contact Information Email Preferred Phone Cell Address City State Zip Emergency

More information

Medication Allergies

Medication Allergies **PLEASE CHECK IN 15 MINUTES PRIOR TO APPOINTMENT WITH FORMS COMPLETED** Primary Provider at Ocotillo Internal Medicine Other Physicians you see: Jonathan Hackenyos, D.O. 1. Cheryl Maurice, M.D. 2. 3.

More information

MenoChat. City State Zip Code. Employer Job Title. Primary Care Provider Phone: History. Desired Outcome:

MenoChat. City State Zip Code. Employer Job Title. Primary Care Provider Phone: History. Desired Outcome: MenoChat Patient Health History Questionnaire Patient Name (last, first, MI): How did you hear of MenoChat? Address City State Zip Code Home Phone #: Cell Phone #: Male or Female Marital Status Email Employer

More information

1. Check with your doctor before starting any new exercise or diet program.

1. Check with your doctor before starting any new exercise or diet program. Extremely Flat Abs Disclaimer See your physician before starting any exercise or nutrition program. Prior to starting, you should discuss all nutritional changes with your physician or a registered dietician.

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Williams CM, Maher CG, Latimer J, et al. Efficacy

More information

WITHDRAWN. Treatment. Zinbryta (daclizumab)

WITHDRAWN. Treatment. Zinbryta (daclizumab) Information for people living with multiple sclerosis What is Zinbryta and how does it work? How is Zinbryta administered? Before you take Zinbryta While you are taking Zinbryta What are the potential

More information

Managing Inflammatory Arthritis. What to Discuss with Your Health Care Team

Managing Inflammatory Arthritis. What to Discuss with Your Health Care Team Managing Inflammatory Arthritis What to Discuss with Your Health Care Team Section 1 Introduction What to Discuss with Your Health Care Team This tool has been created with input from patients to provide

More information

Module 8 Course Manual Christina Lyne

Module 8 Course Manual Christina Lyne Module 8 Course Manual Christina Lyne christina@aromalyne.com Instructions for Module 8 Please take some time to read through this module. Once you have completed the workbook please email it to me for

More information

Premium Specialty: Pediatrics

Premium Specialty: Pediatrics Premium Specialty: Pediatrics Credentialed Specialties include: Adolescent Medicine, Pediatric Adolescent, and Pediatrics This document is designed to be used in conjunction with the UnitedHealth Premium

More information

stoneburner acupuncture

stoneburner acupuncture STONEBURNER ACUPUNCTURE, LLC Erin K. Stoneburner, LAc, MAcOM 1135 SE Salmon St, Suite 211 503.784.1660 stoneburner@gmail.com Date: Name: (First) (Middle) (Last) DOB: _ Age: Sex: Address: City/State: ZIP:

More information

Dr. Sereena Uppal DC Michael Herrewig DC Doctor of Chiropractic th Avenue Surrey BC V4A 2H9 Tel: Fax:

Dr. Sereena Uppal DC Michael Herrewig DC Doctor of Chiropractic th Avenue Surrey BC V4A 2H9 Tel: Fax: Dr. Sereena Uppal DC Michael Herrewig DC Doctor of Chiropractic 690 15355 24 th Avenue Surrey BC V4A 2H9 Tel: 604.541.9336 Fax: 604.541.9308 I. Patient Information Thank you for choosing our practice for

More information

Family Naturopathic Clinic

Family Naturopathic Clinic Mark Orbay, B.Sc., N.D. Doctor of Naturopathic Medicine 265 Carling Avenue, Suite 610 Tel: (613) 230-6100 Fax: (613) 230-0070 Name: Phone (Home) Address: (Office) Date of Birth: / / Age: (Month) (Day)

More information

Contraindications for Massage Therapy

Contraindications for Massage Therapy Contraindications for Massage Therapy Contraindications are certain conditions that a person may have that could be aggravated by the application of Massage Therapy. Although certain conditions may be

More information

MOUNT CARMEL RADIATION ONCOLOGY NEW PATIENT SELF HISTORY/SELF ASSESSMENT FORM

MOUNT CARMEL RADIATION ONCOLOGY NEW PATIENT SELF HISTORY/SELF ASSESSMENT FORM MOUNT CARMEL RADIATION ONCOLOGY NEW PATIENT SELF HISTORY/SELF ASSESSMENT FORM Name: Date Reason for Consultation: Physicians involved in your care: Best Contact Phone #: Can we leave a message: YES NO

More information

COMMUNITY ACUPUNCTURE A USER GUIDE. Statement of Inclusivity and Ethics

COMMUNITY ACUPUNCTURE A USER GUIDE. Statement of Inclusivity and Ethics Statement of Inclusivity and Ethics Hemma Community Acupuncture strives to create a safe and comfortable environment for all members of our community. We welcome people of all genders, sexes, races, colours,

More information

GP Exercise Referral

GP Exercise Referral GP Exercise Referral Course Guide Thank for you your interest in the GP Exercise Referral course with Amac. Within this course guide, you will find information on the different parts of the course. If

More information

The Psychology of Success

The Psychology of Success Overview of Lecture The psychology of motivation The Psychology of Success Emma Butler, Psychologist emma@familypsychologist.com.au Anxiety Mindfulness meditation Hypnosis Health and well-being Tips for

More information

Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac Brant Street, Burlington, Ontario L7R 2J9 (905) Fax (905)

Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac Brant Street, Burlington, Ontario L7R 2J9 (905) Fax (905) Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac. Personal History: Name: Address: City: Province: Postal Code: Birth date: day /month /year Age: Sex: M F Home Phone: Business Phone: Cell Phone: E-mail: Health

More information

UNIT 1: CELLS, SKIN, & SENSORY ORGANS

UNIT 1: CELLS, SKIN, & SENSORY ORGANS Anatomy UNIT 1: CELLS, SKIN, & SENSORY ORGANS Section 1.1: Intro to Anatomy Section 1.2: Cell & Skin Anatomy Section 1.3: Sensory Organs Learning Objectives Compare ic and regional anatomy Evaluate the

More information

Provide body massage treatments

Provide body massage treatments Provide body massage treatments A/600/7462 Learner name: Learner number: VTCT is the specialist awarding body for the Hairdressing, Beauty Therapy, Complementary Therapy and Sport and Active Leisure sectors,

More information

Physiological disorders

Physiological disorders Physiological disorders Overview of major causes and signs and symptoms Learning Aim A: Tuesday 7 th February 2017 Grading Criteria Causative factors in physiological disorders Aetiology is the medical

More information

self care what is self care? caring a pack to start conversations... THE NHS SAYS But can it mean more? mental wellbeing minor ailments

self care what is self care? caring a pack to start conversations... THE NHS SAYS But can it mean more? mental wellbeing minor ailments self care In Dudley borough mental wellbeing what is self care? THE NHS SAYS minor ailments long term conditions caring role of professionals Self care is about keeping fit and healthy, understanding when

More information

UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty

UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty UnitedHealth Premium Physician Designation Program Episode Treatment Groups (ETG ) Description and Specialty 666700 Acne Family Medicine, Internal Medicine, Pediatrics 438300 Acute Bronchitis Allergy,

More information

Saleeby Chiropractic Centre, P.A.

Saleeby Chiropractic Centre, P.A. Saleeby Chiropractic Centre, P.A. Stephen M. Saleeby, D.C. Wayne J. Prickett, D.C. Today s Date: / / Chiropractic Intake Z: Name: DOB: / / Age: First MI Last Preferred Name: Address City State Zip Code

More information

Personal &Work Information Date: Patient Name: Age: City: State: Zip: Primary Care Physician: PCP Phone:

Personal &Work Information Date: Patient Name: Age: City: State: Zip: Primary Care Physician: PCP Phone: Personal &Work Information Date: Patient Name: Age: Birth Date: / / Preferred Name: Gender: Home Phone: Address: Mobile Phone: City: State: Zip: Occupation: Employer: Work Phone: Email: Emergency Contact:

More information

Red Comet. Anatomy. *This course is recommended for grades UNIT 1: CELLS, SKIN, & SENSORY ORGANS. (Time Estimate for Content Study 15 hours)

Red Comet. Anatomy. *This course is recommended for grades UNIT 1: CELLS, SKIN, & SENSORY ORGANS. (Time Estimate for Content Study 15 hours) Red Comet Anatomy In this course students will explore the anatomy or structure of the human body. In addition to learning anatomical terminology, students will study and the main systems of the body including

More information

Over. Signature of Patient/Parent/Guardian: Date: / / Date: / / Patient s Name: For ADULT Patients : Employer: Address: Occupation:

Over. Signature of Patient/Parent/Guardian: Date: / / Date: / / Patient s Name: For ADULT Patients : Employer: Address: Occupation: Date: / / Patient s Name: Address: Preferred Home: ( ) - Work: ( ) - Cell: ( ) - Text Message Reminders : Yes No Social Security #: Date of Birth: - - / / For ADULT Patients : Employer: Occupation: Spouse

More information

Name: Date of birth: Address: City: State: Zip: Phone: (day) (evening): (cell): address: Occupation: Who referred you/how did you hear about us?

Name: Date of birth: Address: City: State: Zip: Phone: (day) (evening): (cell):  address: Occupation: Who referred you/how did you hear about us? Name: Date of birth: Address: City: State: Zip: Phone: (day) (evening): (cell): Email address: Occupation: Who referred you/how did you hear about us? Your primary health care provider: Phone: Emergency

More information

Hormone Evaluation Quiz

Hormone Evaluation Quiz Hormone Evaluation Quiz confusion & frustration understanding & empowerment Find Your FLO! Ø Follow the instructions in each of the 4 categories Ø Tally up your results Ø Discover how to interpret your

More information

Personal Health Evaluation

Personal Health Evaluation Personal Health Evaluation Note: Information provided on this forms will be held in strict confidence. I. Personal Information Name Age Sex Height Weight Eye Color Phone Number or Skype Number you wish

More information

Self Help Holds For Every Day

Self Help Holds For Every Day Self Help Holds For Every Day Prepared by Astrid Kauffmann Jin Shin Jyutsu Practitioner and Self Help Teacher www.flowsforlife.com When I have a tummy ache I hold one of my thumbs. Within seconds to minutes,

More information

Thai Massage Health History Questionnaire

Thai Massage Health History Questionnaire Name: Date: Thai Massage Health History Questionnaire Mobile Work Home Email Birthday Address Emergency Contact Name Relationship number Occupation How did you find me? When was your last massage? Where?

More information

HOMEOSTASIS & IMMUNITY Week Two Packet

HOMEOSTASIS & IMMUNITY Week Two Packet Ms. Scott HOMEOSTASIS & IMMUNITY Week Two Packet Packet Grade: / 9 Completed notes / 30 Completed Classwork / 30 Completed Homework / 10 Packet turned in on time / 1 Name and Class are filled in / 80 Total

More information

Prescribing of over the counter medicines is changing

Prescribing of over the counter medicines is changing Prescribing of over the counter medicines is changing NHS England held a consultation on some changes to prescribing medication you can buy over the counter. This medication can be bought over the counter

More information

Southwest Service Life Insurance Company

Southwest Service Life Insurance Company Southwest Service Life Insurance Company UNDERWRITING GUIDE 2/2012 95587v1Proof.indd 1 95587v1Proof.indd 2 95587v1Proof.indd 3 Acne A A A ADD A A A Addison s Disease D A D AIDS, ARC, HIV Infection D D

More information

DIAPPERS: Transient Causes of Urinary Incontinence and other contributing factors

DIAPPERS: Transient Causes of Urinary Incontinence and other contributing factors DIAPPERS: Transient Causes of Urinary Incontinence and other contributing factors D Delirium Acute confusion alters one s ability to anticipate and meet own needs. Delirium may occur from drugs, surgery,

More information

Welcome to Medina Family Chiropractic and Acupuncture!

Welcome to Medina Family Chiropractic and Acupuncture! Welcome to Medina Family Chiropractic and Acupuncture! Please fill out this form and return it to the front desk. Let us know if you have any questions! Personal information Date: First name: Middle name:

More information

Patient Clinic Leaflet. chronic fatigue syndrome (CFS) myalgic encephalomyelitis or myalgic encephalopathy (ME)

Patient Clinic Leaflet. chronic fatigue syndrome (CFS) myalgic encephalomyelitis or myalgic encephalopathy (ME) Patient Clinic Leaflet Basic information on your illness and the treatments we can offer you for chronic fatigue syndrome (CFS) also known as myalgic encephalomyelitis or myalgic encephalopathy (ME) Chronic

More information

UNIT 1: INTRODUCTION AND HERBAL REVIEW

UNIT 1: INTRODUCTION AND HERBAL REVIEW INTERMEDIATE HERBAL COURSE OUTLINE UNIT 1: INTRODUCTION AND HERBAL REVIEW Lesson 1: Let s Get Started! Lesson 2: Introduction to the Intermediate Course Why Choose Herbs? An Ecological Relationship How

More information

Patient Admittance Form

Patient Admittance Form Patient Admittance Form Mah Chiropractic Clinic 7222 Edgemont Blvd. N.W. World Health Club Calgary, AB. T3A 2X7 Phone: (403) 241-1886 Fax: (403) 241-0995 Name: (Family) (First) (Initial) Sex: Male Female

More information

Inflammation. Answer: Diseases Believed to Stem from Chronic Inflammation. Signs of inflammation Yang Condition

Inflammation. Answer: Diseases Believed to Stem from Chronic Inflammation. Signs of inflammation Yang Condition Inflammation Latin inflammatio To set on Fire (conditions ending in -itis) 24 Million have an auto-immune disease 50 Million have Allergies 50 Million have Asthma 60 Million have IBS Which of these do

More information

Pediatric Intake Form (6-12 years) Age: Date of Birth: / / Gender (circle one): female or male

Pediatric Intake Form (6-12 years) Age: Date of Birth: / / Gender (circle one): female or male www.monctonnaturopathic.com 12 Fifth Street, Moncton, NB, E1E 3G9 Ph: 506-382-1329 Fax: 506-382-1828 Pediatric Intake Form (6-12 years) Name: Date: Age: Date of Birth: / / Gender (circle one): female or

More information

Personal Health Profile. Address:

Personal Health Profile. Address: 1 P age Personal Health Profile Initials: Personal Health Profile Name: Address: Date: Phone Numbers: Home: Work: Fax: E- mail: Date of Birth: Age: Weight: Height: Blood Type: Occupation: Relationship

More information

Traditional Chinese Medicine

Traditional Chinese Medicine Traditional Chinese Medicine Oriental Medicine (OM) pre-dates modern western medicine by more than a thousand years. It has grown and developed into a comprehensive health care system with a continuous

More information

Physiotherapy Assessment (Condition > 4 weeks)

Physiotherapy Assessment (Condition > 4 weeks) Greg de Jong: Physiotherapist & Nutritionist 35 Beach Street Merimbula NSW 2548 Ph: 02 64951097 Fax: 02 64951397 Physiotherapy Assessment (Condition > 4 weeks) By accurately and in detail completing this

More information

Ronald Steriti, ND, PhD 1284 Granada Blvd Naples, FL (239)

Ronald Steriti, ND, PhD 1284 Granada Blvd Naples, FL (239) Ronald Steriti, ND, PhD 1284 Granada Blvd Naples, FL 34102 (239) 659-2684 ron@naturdoctor.com www.naturdoctor.com Finding the Cause of Disease with Specialty Lab Tests Finding the Cause of Disease with

More information

Anatomy, Physiology, & Disease 3rd Edition, 2016

Anatomy, Physiology, & Disease 3rd Edition, 2016 A Correlation of Anatomy, Physiology, & Disease 3rd Edition, 2016 To the Mississippi Curriculum Framework Health Sciences Core II 2008 CTE Health Sciences Frameworks Table of Contents Unit 6: Vital Organs

More information

The Food Intolerance Institute of Australia

The Food Intolerance Institute of Australia The Intolerance Institute of Australia The Symptoms Matrix The Symptoms Matrix allows you to narrow the possibilities of your food rather than diagnose it. To get an accurate identification of your food

More information

F E L D E N K R A I S

F E L D E N K R A I S F E L D E N K R A I S R E S O U R C E S AUDIO PROGRAM USER S GUIDE 2008 Feldenkrais Resources 3680 6th Avenue San Diego, CA 92103 619/220-8776 800/765-1907 fax: 619/330-4993 info@feldenkraisresources.com

More information

PHYSICAL REHABILITATION ADVICE

PHYSICAL REHABILITATION ADVICE PHYSICAL REHABILITATION ADVICE WHAT IS REHABILITATION? Rehabilitation combines various approaches to help your body function in a healthy way and prevent reoccurrences or future injuries. It works in a

More information

NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C.

NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C. NORTHERN VIRGINIA PULMONARY AND CRITICAL CARE ASSOCIATES, P.C. Past Medical History AIDS/HIV disease Anemia Asthma Bronchitis Cancer Date of last Chest X-ray Diabetes Mellitus, Type I Diabetes Mellitus,

More information

New Patient Intake Form Pickering Chiropractic Health Centre 1154 Kingston Road Pickering ON, L1V 1B4

New Patient Intake Form Pickering Chiropractic Health Centre 1154 Kingston Road Pickering ON, L1V 1B4 New Patient Intake Form Pickering Chiropractic Health Centre 1154 Kingston Road Pickering ON, L1V 1B4 Date: Name Age Date of Birth Address Postal Code Occupation Phone (home) (work) Okay to leave a message?

More information

WELCOME TO THE BURLINGTON NATURAL HEALTH CENTRE PLEASE FILL IN THESE FORMS AS COMPLETELY AS POSSIBLE. THANKYOU!

WELCOME TO THE BURLINGTON NATURAL HEALTH CENTRE PLEASE FILL IN THESE FORMS AS COMPLETELY AS POSSIBLE. THANKYOU! WELCOME TO THE BURLINGTON NATURAL HEALTH CENTRE PLEASE FILL IN THESE FORMS AS COMPLETELY AS POSSIBLE. THANKYOU! NAME DATE ADDRESS Gender CITY, PROVINCE HOME PHONE E MAIL POSTAL CODE DATE OF BIRTH (D/M/Y)

More information

Patient Medical History

Patient Medical History #3 1810, 8 th Street East, Saskatoon SK S7H0T6 Phone (306) 373-5209 Fax (306) 373 5207 Michelle Kormos, Osteopathy (current study) Patient Medical History Please complete the entire medical history and

More information

THE HORMONE HEALTH PROFILE

THE HORMONE HEALTH PROFILE THE HORMONE HEALTH PROFILE The following checklists created by Natasha Turner,N.D. will help identify hormone imbalances quickly. Your profile results from these checklists will be extremely valuable in

More information

Person Served Health Care Providers. Address Tel Number Fax

Person Served Health Care Providers. Address Tel Number Fax Page 1 Organization Name: Provider Primary Care Physician Psychiatrist Name and Credentials Person Served Health Care Providers Admission: Address Tel Number Fax last exam Dentist Neurologist Ophthalmologist

More information

CHRONIC TREATMENT GUIDELINES

CHRONIC TREATMENT GUIDELINES CHRONIC TREATMENT GUIDELINES REGISTRATION OF CHRONIC CONDITIONS You can only access benefits for chronic medication, as listed below, if your prescribing/treating doctor or pharmacist registers your chronic

More information