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Client Intake

**Please take a moment to carefully read our policies and the liability            below. By submitting this form, you acknowledge that you read, understood, and agree to our policies and the terms outlined in the liability 
 

waiver

waiver.

Birthday

Massage Information

Have you had a professional massage before?
Reason for seeking massage:
How much pressure do you prefer?

Client Intake Form-Health Information

Select all that apply:
Are you taking any medications?
Any allergies? (oils, scents, nuts, etc)
Are you pregnant?
Are you currently under medical supervision or receiving other medical intervention?
Recent injuries, surgeries or medical procedures in the past 2 years?

By signing below, I acknowledge that I am aware of the benefits and risks of massage therapy and that I have completed this form to the best of my knowledge. I also agree to inform my massage therapist of any health or medical changes.

By signing below I also acknowledge that I have read and understand the policies and liability waiver and agree to its terms, releasing Pursue Healing and its therapists from any and all liability related to the massage therapy services provided.

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