Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Sexo: ( )M ( ) F
Data de nascto: __/__/____ Idade: ___ Profisso: ______________ Estado Civil:______________
Peso: ____ Altura: _______ IMC: _______ Fones:______________________________________
E-mail: ______________________________________________ Facebook:__________________
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Assinatura do Paciente
Atesto para fins de direito que as informaes que por mim aqui prestadas so
verdicas, pois daro base para intervenes de massoterapia.
( ) outros especifique:
3 Histrico Familiar
( ) Problemas Respiratrios ( ) Cardiovasculares ( ) Hipertenso ( ) Obesidade e Dislipidemias
Especifique:
Vista Posterior
7) Avaliao Postural:
Cifose( ) Lordose( ) Escoliose( )
Joelho: Valgo( ) Varo( )
P: Cavo( ) Plano( ) Normal ( )
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TRATAMENTO
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Observaes Adicionais: _______________________________________________________________________________________
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Massoterapeuta:____________________________________________________