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 Service Prices & Plans 

AquaStretch and Massage  Services

Health Assessment Form

Please fill in the  health assessment form for your first session,  please take a few minutes to fill this out, or the paper version with you to the first session, so we can understand all Issues, symptoms & goals in preparation for Aqua Stretch Myofascia Release Therapy and aid any underlying issues and assist you in Moving with Ease in the best possible way. 

Health Assessment Form: Aqua Stretch Myofascia Release Technique

www.movingwithease.au 0432 375 922 Info@movingwithease.au

Please complete prior to your first Aqua Stretch Myofascial Release session

Birthday
Day
Month
Year
Have you been referred by a GP or a Specialist Doctor?
Yes
No
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