Private Health Funds Available Now at angelique Thai Massage & Beauty Spa.

Please call 0478 731 111 for appointment with our Health Fund Providers to make a claim.
HICAPS claims on the spot is available. Please check your cover and gap payment in store with your private health insurance card.

** Please note: All Private health funds cannot be used for special promotion or Gift Voucher

Confidential Client History Form Remedial Treatment











    GENERAL HEALTH SCREEN



    LIFESTYLE HABITS









    Previous Diagnostic / Surgical / Illness / Accidents


    Health History




    (including aspirin, ibuprofen, vitamins, herbs, homeopathic and naturopathic remedies)


    (location and duration or onset)

    (how it happened - position / direction etc)

    (constant / with movement / with activity / sharp / shooting / dull / aching etc)

    (activities / posture / stressors)

    (movement/rest/posture/heat/cold)

    (include all health care types – Complementary Medicine Practitioner and / or Medical Doctor, Physiotherapist, Osteopath, Chiropractor, Dentist)

    Please indicate from the diagram below, the area that are affected or that are painful.



    Only sign below if the above information is understood and has occurred