Kathleen M. Murphy, LMT CNMT CMTPT
Practicing in Annapolis, Maryland

Client Forms

Prior to your first appointment, please print out, review, and complete the following forms. You will need to bring a completed copy of your Client Health History and Privacy Policies Acknowledgement with you to your initial session.

 

Client Health History

This is a standard health history form, including an informed consent to treatment. Please fill out completely, and sign and date the form at the bottom.

If you have topical allergies or chemical sensitivities --- prior to your first session, please review the Ingredient Lists of the lotions, gels, and oils I use to ensure they are approprite for you --- thank you!

 

Privacy Policies Notice

This is a notification of privacy policies regarding client information, as required by both HIPAA (The Health Insurance Portability and Accountability Act of 1996) and Maryland law. Please review this form and retain it for your records.

 

Privacy Policies Acknowledgement

This is a form acknowledging that you have read and understood the Privacy Policies Notice; it also provides the means by which I may contact you. Please fill out completely, and sign and date the form at the bottom.

 

Associated Bodywork & Massage Professionals
© Copyright 2018 Kathleen M. Murphy, LMT CNMT CMTPT. All rights reserved.