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Birthday
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Day
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Have you had a massage before?
Yes
No
** Please mark any of the following conditions you may currently have
  • I hereby state that, to the best of my knowledge, all my answers are correct.

  • I understand that my personal health information will be collected, and that all information that I provide will be kept confidential unless required by law.

  • I will inform the therapist of my current condition at the time of each visit.

  • Massage should never be something that "just happens" to you—it is something we do together. You are in control of your session at all times. You may request changes in pressure, temperature, techniques, draping, music, conversation, positioning, or ask to pause or end the session at any time, for any reason. Open communication helps ensure a safe, comfortable, and effective experience.

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