Health And Well-Being History Form (VMLD)
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 your first BodyTalk session with Sahan. If you have completed a BodyTalk Health and Well-Being Form for Sahan in the past, you are NOT required to complete this form. The form serves two purposes:
- Self-Assesment: The form will help you bring into awareness your physical, mental and emotional health, and your stresses such as family, relationships, work and finances that you could potentially improve.
- Evaluation: The form is used at follow-up sessions to evaluate changes you have experienced since the previous BodyTalk session. It allows you and the practitioner to see where there is room for improvement. Evaluating your 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 honestly and 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.