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Client Name:
Address:
Profession:
Tel. No: Day
Eve:
4050
5060
60+
Acne
Eczema
Psoriasis
FIGURE DIAGNOSIS
Height:
Weight:
Skin type:
Postural conditions:
MEASUREMENTS:
Top of thigh: Right: Left:
Upper chest (under the arms):
1inch/2cm above knee: R: L: Maximum chest:
Maximum calf muscle: R: L: Below bust:
Ankle: R: L:
Waist:
Middle of upper arm: R: L:
Hips:
Middle of lower arm: R: L:
Maximum buttocks (on hairline):
Wrist: R: L:
TESTS
Nerve sensitivity test: Yes No
Heat sensitivity test: Yes No
Pulse check: Yes No Resting Pulse Rate
Treatment details:
(Treatment selected, methods and products used, treatment duration)
Client Feedback:
Clients signature...........................................................
Learners signature.....................................................