Health | The Awen Room

🌿 Pre‑Treatment Health Check

Hello!

To make sure your treatment is safe and supportive, please take a moment to fill out this quick health check. It should only take a minute.

All information is kept private and confidential. 💫

First name

Last name

Email

Phone

In the past 7 days, have you experienced any cold or flu‑like symptoms?

Yes

No

Have you recently had (or been exposed to) any of the following?

COVID

RSV (Respiratory Syncytial Virus)

INFLUENZA

None of the above

Do you currently have any cuts, abrasions, or open wounds?

Yes

No

If Yes Please Expain

Do you currently have any rashes, fungal infections, or other contagious skin conditions?

Yes

No

If Yes Please Expain

Are you currently undergoing treatment for a major health condition (such as cancer, recent surgery, or another serious illness)?

Could you be pregnant? (Please note: I don’t currently offer treatments during pregnancy.)

Yes

No

What would you like me to know to best support you in this session? (For example: are you feeling sore or stiff and needing muscle work, seeking energy work, emotional stress relief, or simply wanting deep rest?)