Form for Autism 

Form for General Intake

Medical Consent Form/Contraindications

Healthcare Environment Consent Form

Healthcare Provider Release Form

You can save time at your first appointment by bringing your completed intake and medical consent forms. If your child has special medical needs or recently underwent surgery or other medical procedures I may ask-- after discussing with you about the specifics-- that you discuss pediatric massage with your pediatrician and get their signature before continuing with hands-on work. We can still practice the massage strokes on a doll as things are sorted out and the massage strokes can be easily modified to accommodate your child’s unique needs. If you forget to print out/fill out the forms I will have extra copies on hand.

Forms written by Tina Allen

Contact us

Ballard

Seattle, WA  98107

axjmd2@gmail.com

 

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