Biomechanical
Communication
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Phone: 66-99-362-1005
Email: info@biomc.com

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Biomechanical Communication (BMC)

Muscle Activation Techniques (MAT)
Resistance Training Specialist (RTS)
Rolfing
Acupuncture
Active Isolated Stretching (AIS)
Massage



MAKE APPOINTMENT

1. Please wear comfortable outfit or bring wrap.

2. Please wear bathingsuit if you want to photograph your posture.

3. Cancellation must be 24 hours BEFORE session or CANCELLATION FEE will be charged for the amount of session.

4. Read and agree to the Treatment Agreement.

 

Email the following information to: info@biomc.com

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Patient Name:

Address1:
Address2:
City:
Zip/Postal Code:

Email:

Daytime Phone:
Evening Phone:

Time Preference:
1st Choice:
2nd Choice:

Were you Referred?
By Whom:

New or Existing Patient:

Goal of treatment:
Describe any discomfort:
How long have you had these symptoms?
Describe any history of illness or family illness:

Any questions?

I agree to the Treatment Agreement: Yes
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