Disclaimer:
This form is a self-assessment tool designed to assist MeziTouch Rehab in understanding your needs and providing appropriate care.
Completion of this form does not constitute a formal diagnosis. All information provided is strictly confidential and will only be used by qualified professionals involved in your care. If you're in immediate danger or experiencing a crisis, please seek emergency assistance.
By submitting this form, you acknowledge that the information is accurate to the best of your knowledge.
Professional care. Personal support.