www.thebodyworker.com

Massage School Notes

Julie Onofrio, LMP
1402 Third Ave. Suite 1428
Seattle, WA 98101
206-623-1391 To: _____________________________
Progress Report as of : ___/___/____
Regarding:_______________________
Number of treatments:______________
Current Rx expires:________________
Overall Patient Progress is: ___Poor ___Marginal ___Good ___Excellent
Subjective and Objective Observations

	Left	Right	No current problem	Improving	Not  Improving	Increased  Symptoms
Neck
Shoulder
Arm
Upper Back
Mid- Back
Low Back
Pelvis
Hips
Legs

 

Patient rates their stress level as: ___Low ___Moderate ___ High

Treatment Plan_________________________________________________________________
______________________________________________________________________________________
Other Concerns/Comments:_______________________________________________________
_____________________________________________________________________________

Thank you for your referral.

Please contact me with any questions.

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