Atlanta Colonic & Massage - Health History Forms

For your convenience, we have provided our Health History Forms in Adobe .pdf format (below) so that you may print, complete, and bring them with you to your appointment.

We hope to soon have interactive online health history forms available.

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Prior to your first visit, you may select, print and complete the Basic Heath History Form plus any Addendum forms for each particular service desired.

Atlanta Colonic & Massage - Basic Health History Form

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Colonic History Form - Addendum

Ionic FootSpa History Form - Addendum

Therapeutic Massage History Form - Addendum

Far IR Sauna History Form - Addendum

If you have any questions, comments or concerns or would like to schedule an appointment, please feel free to contact us:

770-558-6900

atlantacolonic@bellsouth.net

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NOTICE: All personal health information provided is used, controlled and secured in strict compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA Privacy Rules).

Your personal identifiable health information will never be given away, sold or disclosed to any outside agency, company or organization, nor will it be released for any purpose other than collection of account payment, or as required by state or federal laws, or anonymously compiled for research purposes, without your written authorization.