Watsu Client Form | Manaia Wellness

Watsu®Aquatic Therapy Client Form

Please complete this form so we can begin working together.

Contact & Personal Information.

These questions are intended to help you express your current , concerns or medical conditions and provide me with the information, to help create the Watsu sessions to suit your needs.

Please take all the time you need to complete this before submitting. All responses are kept confidential and private as per the Watsu®(WABA) Guidelines for Ethical conduct.

First name

Last name

Phone

Email

State and Postcode

Emergency contact and phone number

Any other medical conditions? Or any medical conditions you need to clarify? If any medical condition changes in any way. Please inform your therapist.

Is there anything else you would like to share at this time?

Is there anything else you would like to share with us about yourself, your condition , your specific problems or needs

If you have never received a Watsu session before, please inform your therapist so that we can fully explain the treatment before your session. How did you find Manaia Wellness, or who can we thank for referring you?

Signature

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