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Client Intake 

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.

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