Services de Santé Globale
"La Santé c'est notre Affaire"
514-500-5567
514-733-3668
English
ACCUEIL
Trucs SOS
PROFIL
Mission
Témoignage
Emplois
SERVICE AUX PATIENTS
Physiothérapie
Massothérapie
Ergothérapie
Ostéopathie
Acupuncture
Entraînement Personnalisé
SERVICES CORPORATIFS
Massage Sur Chaise
Évaluation Posturale
Questionnaire d'Histoire Medicale
Programme Corporatif de Partenariat
Pour plus d'Information
À DOMICILE
NOUS CONTACTER
Références
Prendre un Rendez-Vous
Services Corporatifs
GENERAL INFORMATION
First Name
Sex
Male
Female
Last Name
Occupation
Employer's name
Address
Tel(Home)
Postal code
Tel(Mobile)
Tel(Work)
Birthdate(d/m/y)
Email
Hand Dominance
Right
Left
Age
Sleep Position
Sleep Quality
Good
Mod
Bad
PRESENT HISTORY
Are you followed by a Doctor?
Name
Are you followed by a Physiotherapist?
Name
If yes, for what condition?
Do you take medication?
If yes, which?
PAST MEDICAL HISTORY
Allergies
Yes
No
Osteo-Arthritis
Yes
No
Circulation
Yes
No
Tendinitis
Yes
No
Muscular
Yes
No
Bursitis
Yes
No
Respiratory
Yes
No
Fibromyalgia
Yes
No
Digestive System
Yes
No
Ostieoporosis
Yes
No
Nervous System
Yes
No
Asthama
Yes
No
Arthritis
Yes
No
Pregnancy
Yes
No
#Month
Further notes
Stress Level
High
Medium
Low
Normal
Contactez-nous