top of page


What follows is a consolidated contact / therapy / medical info form. You can use this for any session offered at ETMT. There are some specific questions contained that relate to conditions that are contra-indicated (unsafe), or that require alterations to the therapy session. Please be as forthcoming as possible so that you can enjoy a safe and healthy experience! 

Also, the more detail you can provide, the better. Near the bottom of the form is a box labeled "subjective," where you can expand on any elements you wish. Many issues are complex, and the added detail helps to provide a more complete picture of what's happening. These are all questions I will ask at the outset of your session if not answered, and a few minutes spent responding now can net you more time in treatment.


Please note also, that once you click the "submit" button, your responses will be sent and there will be no more opportunity to edit them.

All data collected is kept strictly confidential, and is transmitted via https internet security protocol. Every effort has been made to keep your sensitive information private and secure. If you would like a secure direct link to the form server, click HERE.


bottom of page