IHM medical questions for consultation form - Please Help!!

[Go Fight Love]

Hi all,

I have to design a consultation card as part of my assessment on my IHM couse, but after completing it I dont think there is enough medical questions on there, does anyone know what should be included? any help with this will be greatly appreciated I have pasted on here the original form Imade below.


Date of InitialConsultation………………………………………………………………………

Clients Title Mr / Mrs / Miss / Ms / Other…………………………………………………………
Clients Name…………………………………………………………………………………………………………..
Address…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………..
Telephone No. ……………………………………………………………………………………
Email Address…………………………………………………………………………………………
Occupation……………………………………………………………………………………………………………..

Female Clients:
Is it possible you may be pregnant?.........................................................................................
Date of last menstrual period……………………………………………………………………

Are there any medicalconditions that may affect the proposed treatment?
Details…………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………..

Are you currently taking any medication?
Details including dosages………………………………………………………………………
…………………………………………………………………………………………………………………………..

Your GP’s Name and Address…………………………………………………………………
…………………………………………………………………………………………………………………………..
Tel.No…………………………………………………………………………………………………………………..

Is your general health/Immunity Good, Poor, or Average
Are your stress levels High, Low, Medium
Are your energy levels High, Medium, or Low
Details…………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………..

Client Declaration

I declare that the information I have given is correct as far as I am aware, I can undertake the treatment without no adverse effects.
I have been fully informed about the treatment and contra-indications and I am therefore willing to proceed with the treatment.
I understand that Indian Head Massage does not substitute medical treatment.

Cost of treatment: £

Client Signature………………………………………………………………………………………...

 

[Pompal 09.]

Hi,
It looks good so far but I have a lot more medical info on mine. I've pasted it below so you can see what I have, it is based on the one I used in college.

Date of initial consultation:Client Ref: Client name:Title: Address: Telephone number: Date of birth: Occupation: Medical details: Do you have/have you ever suffered with: (Please give dates and details) High temperature or fever? Y/N Acute infectious disease? Y/N Skin infections? Y/N Recent haemorrhage? Y/N &n

 

[Douglassnigue]

Hi Jill,

I have a consultation form for IHM which I previously used for ITEC assignments. It is similar to Claire's one. I have it in a word document and would be happy to forward by PM if it will be of help to you.


Blessings,

Rachel