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Health History Form

Hello and thank you for booking!

Before our session together, I kindly ask that you complete the Health History Form on this page and bring it with you to your appointment.

Fill it out to your comfort level but please know that it will be most helpful for me to understand your health history so that I may deliver treatment in a safe and effective manner.

Please feel free to contact me if you have any questions or concerns.

Thank you.

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(book here)

The Peaceful Healing Place

1700 E. Algonquin Road

Suite 218

Algonquin, IL 60102

enter through the doors marked "Professional Suites 201-218"

847/877-4230

Ninetta Keenan, aobta-cp, bctmb, apce

Certified Practitioner of Classic Asian Medicine,

NCBTMB Board Certified Bodywork Professional, 

NCBTMB Approved Continuing Education Provider

Hours:

Tuesday - 1-8pm

Wednesday - 10am-8pm

Thursday - 10am-8pm

Friday - 1-7pm

Saturday - 10am-4pm

Sunday - call for appt

Monday - call for appt

Contact

Thanks for submitting!

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© 2026 by Ninetta Keenan

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