Health Summary Form

$40.00 (incl GST)

  • download as a Microsoft Office Word document
  • save to your computer
  • customise to meet your clinic requirements
  • add your logo and your contact information
  • remove any sections not needed
  • sections include:
    • client details
    • medical history
    • lymphoedema history
    • lipoedema history
    • musculoskeletal history
    • an “I’m not sure” page
    • body chart and notes section (for recording any testing)
    • consent
    • client signature and date

I have my Health Summary Form as a fillable form which is emailed to clients with their booking confirmation for secure upload and email back to me.

NOTE: 2 downloads only. Save to your computer for future printing.
EXPIRY: you must download within 30 days from date of purchase.


This Health Summary Form comes to you as a Word document for easy editing. A downloadable and editable form ready to use or edit as required. Sections include client details, medical history, lymphoedema history, lipoedema history, musculoskeletal history as well as a body chart, notes section, informed consent and space for the client to sign and date. It is easy to remove and/or copy and paste sections to edit to meet the requirements of your practice (e.g orthopaedic testing).

Please note: you have two (2) downloads only - no not for a colleague. It's in case you have technical difficulties. I have kept the price low so your colleague can afford to purchase their own. This link will expire in 30 days. That means that this download will not be available after 30 days from the date of purchase. Therefore, it is advisable to save this form to your computer and then you can print out as required.  You will need to re-purchase after this time.

The author takes no responsibility for any information left on the health history form that could mislead your clients as to your qualification and ability to perform said modalities. Please read the health summary form carefully and remove/replace all sections that do not apply.

error: Content is protected !!