Please submit the following information prior to your massage appointment. After you complete this form you will be automatically redirected to the Client Status Report, which we ask you to print, complete, and bring with you to your appointment.
If you prefer, you may print hard copies of both forms and bring them, completed, to your appointment. A PDF version of both forms can be found here:
Client Intake Forms Printout
Have you ever had any of the following conditions?
Are you CURRENTLY experiencing any of the following conditions?
It is my choice to receive massage therapy. I realize that the treatment is being given for the well-being of my body and mind. This includes stress reduction, relief from muscular tension, spasm, pain, or for increasing circulation and energy flow. I agree to communicate with my practitioner anytime I feel like my well- being is being compromised.
I understand that massage practitioners do not diagnose illness, disease, or any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform spinal thrust manipulations. I acknowledge that massage is not a substitute for a medical examination or diagnosis, and that it is recommended that I see a primary health care provider for that service.
I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the massage practitioner updated as to any changes in my medical status.
By checking below, you agree to the above statements and are consenting to the use of your electronic signature in lieu of an original signature on paper.
Employment OpportunitiesClick Here for more information
Contact UsClick Here for more information
South 40The Opportunity to Change Lives
