• V-Steam Intake Form

  •  -  -
    Pick a Date
  •  -
  • Contraindication Screening

  • Sensitivity Screening

  • Excess heat screening

  • Herb Selection

    Mark any that apply and then make the best selection.

  • SETUP (for office use)

    Is the client contraindicated to steam? _____yes  _____ no

    Is the client sensitive? _____ yes  _____ no

    Which setup is best for client?

         ______ Mild Setup   _____ Advanced Setup

    Does the client have excess heat?

        ______ Cloak _____ No Cloak

    Which Herb Selection is Best?

    _____ Cleansing Herbs

    _____ Disinfecting Herbs

    ______ Gentle Herbs

    ______ Cooling Herbs

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  • Should be Empty: