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  • Client Interview Form - Health & Wellness Goals

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    Carmen Fiz
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    Chart1

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    10 views2 pages

    Client Interview Form - Health & Wellness Goals

    Uploaded by

    Carmen Fiz

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Chart1

    Client Interview Form - Health & Wellness Goals

    Name:_ Example Client One___________ Date: May 10, 2008

    Hydrotherapy Treatments & Programs


    Daily Wellness - Physical, Mental, Emotional Energy & Series of Relaxation Hydrotub, Steam or
    Balance Shower Treatments, Series of Relaxation
    _Feeling Stressed, Anxious, Hydro-Table Treatments, Include
    Tired______________ Underwater Hydro-Massage, Include
    _____________________________________________ misting during steam and hydrotub
    _____________________________________________ treatments________________
    _____________________________________________

    Appearance & Beauty Hydrotherapy Treatments & Programs


    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________

    Fitness - Physical, Mental & Emotional Hydrotherapy Treatments & Programs


    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________

    Healthy (Anti) Aging Hydrotherapy Treatments & Programs


    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________

    Prevention - Prevention of Minor & Major Medical


    Hydrotherapy Treatments & Programs
    Problems
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________

    Enhancement - Expression of latent human potential -


    Hydrotherapy Treatments & Programs
    Physical, Intelligence, Emotional, Spiritual
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________

    Symptoms -Examples: Musculo-skeletal Pain, Tension,


    Hydrotherapy Treatments & Programs
    Anxiety
    Relaxation Hydrotub, Steam or Shower
    _Muscle
    Treatments_____
    Tension_____________________________
    Steam Treatment & Hydro-Table
    _Lower Back
    Massage______________
    Pain____________________________
    _____________________________________________
    _____________________________________________

    Rehabilitation - Acute & Chronic Injuries, Aging Hydrotherapy Treatments & Programs
    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________
    _____________________________________________ _____________________________________________

    http://www.hydrobook.com/chart1.htm (1 of 2)10/29/2010 9:33:29 AM


    Chart1

    Major Medical (Requires recommendation and


    Hydrotherapy Treatments & Programs
    supervision of professional medical personnel)
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________
    _____________________________________________

    http://www.hydrobook.com/chart1.htm (2 of 2)10/29/2010 9:33:29 AM

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