920-373-5002 tpmyotherapy@gmail.com

Please complete the forms below prior to your first appointment

Complete and bring this packet of Evaluation Material Forms to your Trigger Point Myotherapy appointment.  Each form is designed to assist the therapist and to provide you with a safe and effective Trigger Point Myotherapy treatment.  The goal of Trigger Point Myotherapy is to ensure each patient receives positive healthful results.  All forms are necessary to achieve that goal.

For Trigger Point Myotherapy treatments please wear light, loose fitting clothes, (No Blue Jeans or Tank Tops Please).  Trigger Point Myotherapy is administered through clothing.  Shoes are removed for treatments.  Patients will be guided through a series of basic range of motion stretches.  Trigger Point Myotherapy is a non-invasive pressure technique.  The pressure is applied to the muscles to meet the patient’s tolerance level.   The patient works with the Trigger Point Therapist to achieve this goal.  Trigger Point Myotherapy is NOT Massage Therapy.  Treatment protocol does NOT include oils or lotions.


Click on the links below to print your patient forms

Data Form

Health Form

Lifestyle Form

Financial Policy

Wavier Treatment Form





Health Care Professional Referral form Referral Form