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Physician’s Permission form

    Physician's Permission form

    Patient Information Information

    Reason for Permission

    There is no reason to believe that massage or bodywork treatments will harm this patient’s progress. However, please note the following considerations:

    Permission Granted by

    Phone
    Fax
    Email

    Please note: Should you notice anything unusual or significant during treatment, please notify this office immediately.
    Otherwise, any update at the conclusion of care would be appreciated.