Free 30 minute headache/migraine evaluation
So many headaches and migraines are a symptom of trigger points, TMJD, food sensitivities and many other causes that are within your power to control! Instead of just suffering or turning to more medications, lets look for the cause and see if we can eliminate them!
PLEASE DOWNLOAD AND PRINT THE FORM AND TAKE IT TO YOUR DOCTOR AND ASK THEM TO READ
AND SIGN IT, THEN CALL AND MAKE AN APPOINTMENT WITH ME.
(You do not HAVE to have a doctor sign this, but it is helpful for all of us if your doctor is informed about any additional treatment you are trying.)
A gift from Advanced Bodywork & Massage
Mary Jo Smiley CMTPT, MMT, LMT
“My doctor has evaluated my headache/migraine and has found no contraindications to the treatment of the muscles of the neck, shoulders and back.” The possibility of food sensitivities will also be considered.
Please call Mary Jo Smiley CMTPT at 724-494-1468 to set up a free 30 minute evaluation to explore the possibility that myofascial trigger points and myofascial pain and dysfunction are the cause of your headaches, migraines, jaw or other pain. Bring this form already filled out.
I, Dr ________________________________have evaluated & treated (Pt name)__________________________________________for
____headaches, ____migraines, ____jaw or/and ____shoulder and ____neck pain, or other ______________________________________________ pain.
I have not found any pathological cause for the pain that would make hands-on myofascial trigger point therapy or massage contraindicated. I would like you to evaluate my patient for myofascial trigger points that may be the cause of this pain.
Dr’s Name ___________________________________________________
Dr’s Signature:________________________________________________
Dr’s Phone # _________________________________________________
FAX #________________________________
I will report back to your doctor and if you choose to continue treatment, a cost of $70 per hour will be paid at each session. This is not covered by your health insurance, but if you have a health savings or flex spending account, you can probably use it.
Cash, check or credit cards are accepted.
For more information please go to
http://myofascialtherapy.massagetherapy.com
myofascialtherapy@massagetherapy.com (email)
724-494-1468