Beyond Massage Aspen
  • Services
    • Therapeutic Massage
      • Neuromuscular / Trigger Point (Therapeutic)
      • Myofascial Release
      • Ashiatsu Oriental Bar Therapy®
      • Traditional Thai Massage
      • Deep Tissue Massage
      • Prenatal Massage
      • Reflexology
    • Acupuncture
    • Therapeutic Injections
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      • B-12 Injections
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    • Functional Medicine Testing
      • Vitamin Deficiencies
      • Adrenal/Cortisol/Hormone Testing
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    • Instructors
      • Erica Boulangée
      • John Schmidt
      • Natalie Gentry
      • Benny Vaughn
      • Sally Klemm
      • Deane Juhan
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  • Client Info

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  • History

    Background Information on Primary Complaint
  • To better understand the role of acupuncture and Oriental medicine in the care of your primary complaint, I am interested to know what other types of health care professionals you have consulted in the past AND are consulting currently regarding your primary complaint. Please check ALL that apply.
  • What other forms of treatment are you CURRENTLY using specifically for your primary complaint?
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  • Specific Information on Primary Complaint

  • IMPACT ON WORK ACTIVITIES
  • Are you experiencing any of the following issues with your work (inside and outside of the home) by your primary complaint?
  • IMPACT ON SOCIAL ACTIVITIES
  • IMPACT ON EXERCISE ACTIVITIES
  • Are you experiencing any of the following issues with your usual exercise regimen by your primary complaint?
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  • General Health & Well Being Questions:

  • Please use the following letters to indicate if you have any of the following symptoms:

    Sleep:
  • Digestion
  • General
  • Energy
  • Bowel Elimination
  • Emotional State
  • Respiratory
  • Urination
  • Respiratory
  • Eyes
  • Mouth
  • Nose
  • Ears
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  • Consent to Treatment of Minor

  • Because the selected age was below 18, a parent or guardian signature is required. br />
    By my signature below, I hereby authorize beyond massage Aspen Staff to administer massage, bodywork, or somatic therapy techniques to my child or dependent as they deem necessary.
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Beyond Massage Aspen

Address:
300 S. Spring St. Suite 203
Aspen, CO 81611

Phone:
(970) 274-8717

Office Hours

Mon: 9am-6pm
Tue: 9am-6pm
Wed: 9am-6pm
Thu: 9am-6pm
Fri: 9am-6pm

Sat: 11am-6pm

 

 

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