Tilmeldingsskema til Projekt. (PDF)
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Author: lone
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Date:
Diagnose: (Her bør læges eller skoles diagnose anføres)
Barnets navn:
Alder:
Mors navn:
Fars navn:
Adresse:
Tel:
Mail:
Relevant information: F.eks. familie forhold.
Diagnose & symptomer :
Hvornår er situation opstået:
Medicin:
Anden terapi eller behandling:
Skole:
Dato forældrekursus :
Depot / Ansigt
Ansigt:
Hænder:
Fødder:
Andet:
International Institut for Reflex therapy, Lone Sorensen, Barcelona, Spain
0034 678769550
www.reflexologiafacial.es
www.temprana.org
sorensensistem@gmail.com
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