Forms

Underneath you will find forms to download if you wish to have them printed and filled out before your session.

Some of them take some time to fill out, as they are comprehensive.

Please read all descriptions and make sure you get all the forms you need.

These forms contain medical questions pertaining to you and your health. Please fill them out to the best of your knowledge

We are HIPAA Compliant 

Cancer survivors in-treatment or in recent-recovery (6 month after last treatment date), as well as patients with lymphdema, have to get a "Physician's Release" form signed and must bring it for their first appointment.

Long term survivors do not need a "Physician's Release" form signed to receive treatment.

Simply click the icon next to the text for the files you need.

If you are experiencing problems with the forms, you can email us at miechellecmt@gmail.com and we will send you the form by email.

Standard Intake Form

Should be filled out by ALL clients

Oncology Intake Form

Should be filled out if you are a Cancer Survivor

In-treatment

Recent Recovery

Long-Term Survivor

Lymphedema Intake Form

Should be filled out if you have Lymphedema in one, or more areas

This includes Cancer Survivors with lymphedema

Physicians Release Form

Should be filled out by Lymphedema Patients and Cancer Survivors, (in-treatment or recent-recovery)

Call 530 615 9801

Eamil: MiechelleCMT@gmail.com

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