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Wellness Manual Fillable Forms
The Wellness Manual Blank Forms are incredibly cheap yet professional, allowing you to customize all form fields and content.
The LE Wellness Manual Blank Forms Set is a downloadable, customizable collection of all forms in the Manual. Fill out on computer with your name, clinic address, etc., rename and save. Copy, rename for patient, enter data if desired, then save/print. Lymphedema Wellness Manual Blank Forms set.
| Form | Section | Use | Page |
| Health Information & Consent | 2 | Patient Authorization 1 | 231 |
| Notice of Privacy Practices | 2 | Patient Authorization 2 | 233 |
| Photo Release | 2 | Patient Authorization 3 | 235 |
| HIPAA Notice of Privacy Practices | 2 | Patient Disclosure 4 | 239 |
| Patient History & Authorization | 2 | Patient Entry Option 5 | 251 |
| Lymphedema Assessment & Intake | 2 | Therapist Entry 1 | 255 |
| Limb Circumference/Volume | 2 | Therapist Entry 2 | 257 |
| Arm Measurement Form | 2 | Therapist Entry 3 | 259 |
| Leg Measurement Form | 2 | Therapist Entry 4 | 261 |
| Letter of Medical Necessity - Garment | 2 | Therapist Entry 5 | 263 |
| Letter of Medical Necessity - CDT/MLD | 2 | Therapist Entry 6 | 265 |
| Patient Continuing Report | 2 | Therapist Entry 7 | 267 |
| Physician Referral | 2 | Therapist Entry 8 | 269 |
| Physician Guide to CDT/MLD | 2 | Therapist Entry 9 | 271 |
| Tell Me About Lymphedema - Brochure | 2 | Patient Information | 273 |
| Wellness Action Plan (Long Form) | 3 | Patient Entry | 277 |
| Wellness Action Plan (Short Form) | 3 | Patient Entry | 289 |
| My Turn | 3 | Patient Entry | 295 |
| Patient Risk Factors (Long Form) | 4 | Patient Entry | 297 |
| Patient Risk Factors (Short Form) | 4 | Patient Entry | 303 |
| LE Patient Ongoing Checklist | 5 | Patient Action | 305 |
| Patient QOL 36-Item Health Survey | 8 | Patient Entry | 307 |
The LE Wellness Manual Blank Forms assist clinicians and staff to develop individual treatment plans and collaboratively support patients' lymphedema management and treatment decisions.
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Wellness Manual LE Clinic Blank Forms A full set of Wellness Manual Blank Fillable Computer Forms at a small fee. |
Register your Wellness Manual
Register your Lymphedema Wellness Manual to access online bonus features.
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Register your Wellness Manual Register your Lymphedema Wellness Manual to access online bonus features. |
Practice Management CD Brochure
All about Gay Lee's Practice Management System. 2 pages.
See the full Practice Management CD Contents List or Preview the Practice Management CD.
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Practice Forms CD Brochure All about Gay Lee's Practice Management System. 2 pages. |
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Request Access Code Request an access code to restricted areas of the site. |
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Newsletter Subscription
Gay Lee produces Newsletters for Clients, Therapists, and Estheticians with new developments in her practice, teaching, and the field of Manual Lymphatic Drainage massage. Please subscribe to any of the mailings that interest you. If you are weary of them, please unsubscribe.
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Gift Certificate Terms of Purchase
Terms of purchase and license for the Gay Lee's Gift Certificates.
Gift Certificate Terms and Conditions of Purchase
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Gift Certificate Terms of Purchase Terms of purchase and license for the Gay Lee's Gift Certificates. |
Gift Certificate
A Gift Certificate for a massage from Gay Lee is a delightful gift. Gift Certificates never expire and can be redeemed by anyone. Gift Certificates may be used for treatment, consultation, or garment fitment with Gay Lee. Gift Certificates are not redeemable for cash. If Gay Lee's fee schedule has changed before a certificate is redeemed, the redeemer of the certificate is responsible for the difference.
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Gift Certificate Purchase a gift certificate for therapeutic appointment / consultation / garment fitment, with Gay Lee Gulbrandson, CLT-LANA, NCTMB. |
