Carolyn Winbush, LMBT #17304 NC
Customized Integrated Massage Techniques, Certified MediCupping and Massage Cupping Therapy
Client Forms

You may print and complete your Client Health History or any other form prior to your appointment.

If you are under the care of a physician and/or chiropractor, please have them complete the permission/referral form below prior to your appointment. Make sure to bring it with you to your appointment.

First-time Client Health History form
Screening Questionnaire form
Body Map for Clients
Client Feedback form
Physician's Permission form
Physician's Referral form

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