Health And Well-Being History Form for Animals
HIPAA Compliant Data Protection
With a commitment to safeguarding the privacy of client information, this form is compliant with the data storage standards set by the US Health Insurance Portability and Accountability Act (HIPAA) for protecting sensitive patient data and individually identifiable health information.
The form is secured by JotForm, a globally trusted provider headquartered in San Francisco. JotForm will encrypt the data right on the form and then transfer and store the data encrypted. Data is stored in JotForm’s HIPAA compliant servers which are separated from the Internet using multiple levels of protection and firewalls, and the encrypted data is stored in encrypted databases.
You must complete this intake form if this is the Animal’s first BodyTalk Session with Sahan. It is understood that not all questions will apply to your Animal. The form serves two purposes:
- Assessment: The form will help take inventory of the Animal’s current state of physical, mental and emotional health and well-being, and what could potentially improve.
- Evaluation: The form is used at follow-up sessions to evaluate changes the Animal has experienced since the previous BodyTalk session. It allows you and the practitioner to see where there is room for improvement. Evaluating progress is an integral part of every BodyTalk session with Sahan.
Helpful Tips: Use a large screen device when completing this form. Expand the typing space by dragging down the bottom-right edge of each area. Please answer all questions to the best of your ability. Fields marked with an * are required. Use brief sentences and note form. Please do not omit questions: If not applicable, please type “NA.” CAUTION: Do not reload this page as your typed entries will be lost.