Acute & Persistent Chronic Pain & Stress Relief Through
Integrated MyoFascial Release, Massage & Reiki Energy Therapies

Prior to your first visit to Spirit-Mind-Body Massage (SMBmassage), please download forms 1 & 2, and fill them out prior to your first appointment, for then less time will be needed for the initial assessment and more time can be devoted to your massage and energy services. 

Sometimes I might need information from your referring doctor.  To provide me with this information, please download forms 6, 7 and 8.  Have your physician and yourself fill out the appropriate forms.

If you have any questions about these forms, then please  text  me at 408-806-5478 to discuss them.

• 1. Health Information form
• 2. Health Status Update form

• 3. Screening Questionnaire form
• 4. Body Map for Clients
• 5. Client Feedback form

• 6. Physician's Permission form
• 7. Physician's Referral form
• 8. Billing Information form

Namaste, Dusty Rhodes, MS, CMT, CMMP, OMPP
MyoFascial Release & Massage Therapist, Reiki Master and Health Educator 

email: RRhodes9@SMBmassage.com
CAMTC # 67448
NPI # 1477098572

DISCLAIMER:  While the services offered at  Spirit-Mind-Body Massage & Reiki  contribute to relaxation and an improved state of well-being, they are not intended to replace medical diagnosis and treatment.  I recommend first that you consult your physician regarding any illness or injury you might have, and about the complementary treatments provided by SMBmassage. I do not diagnose illnesses or injuries;  nor do I recommend diets, supplements, or medical treatments.