Digital Intake Form

Digital Intake Form

Complete Your Intake, Enhance Your Experience: Your Wellness Journey Starts Here!

It is necessary to fill out the intake form before starting the massage treatment. To streamline the process, it is best to complete the form before your appointment. Completing the form during the appointment takes away from the time allocated for the treatment.

The following information will be used to help plan safe and effective massage sessions. It will be kept confidential. Please answer to the best of your knowledge.

Personal Information
Massage Notes
Health Information
LIABILITY DISCLAIMER STATEMENT
a. I give my permission to receive massage therapy.
b. I understand that therapeutic massage is not a substitute for traditional medical treatment or medications.
c. I understand that the massage therapist does not diagnose illnesses or injuries, or prescribe medications.
d. I have clearance from my physician to receive massage therapy.
e. I understand the risks associated with massage therapy include but are not limited to Superficial bruising, Short-term, Muscle Soreness, Exacerbation of undiscovered injury. I, therefore, release the company and the individual massage therapist from all liability concerning these injuries that may occur during the massage session.
f. I understand the importance of informing my massage therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition.
g. I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so he/she may adjust accordingly.
h. I understand that I or the massage therapist may terminate the session at any time.
i. I have been given a chance to ask questions about the massage therapy session and my questions have been answered.

The following information will be used to help plan safe and effective massage sessions. It will be kept confidential. Please answer to the best of your knowledge.

Personal Information
Health Information
Skin Care History
LIABILITY DISCLAIMER STATEMENT
a. I give my permission to receive massage therapy.
b. I understand that therapeutic massage is not a substitute for traditional medical treatment or medications.
c. I understand that the massage therapist does not diagnose illnesses or injuries, or prescribe medications.
d. I have clearance from my physician to receive massage therapy.
e. I understand the risks associated with massage therapy include but are not limited to Superficial bruising, Short-term, Muscle Soreness, Exacerbation of undiscovered injury. I, therefore, release the company and the individual massage therapist from all liability concerning these injuries that may occur during the massage session.
f. I understand the importance of informing my massage therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition.
g. I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so he/she may adjust accordingly.
h. I understand that I or the massage therapist may terminate the session at any time.
i. I have been given a chance to ask questions about the massage therapy session and my questions have been answered.

CANCELATION POLICY

I truly understand that life can be unpredictable. If you need to cancel or reschedule, kindly let me know at least 24 hours in advance. This allows someone else to take the spot and ensures it's not left vacant.

If you're feeling unwell, please call as soon as you realize you won't make your appointment as a courtesy to others.

SEND ME A MESSAGE

SEND ME A MESSAGE