5 minutes to complete
Any individual who is willing to get massage therapy must be 18 years or above.
How did you hear about our office?
What are the reasons for seeking massage therapy at this time?
Do you have any current or past health conditions that we should be aware of?
Do you have any current or past injuries that we should be aware of?
Do you have any current or past medications that we should be aware of?
What are your current stress levels?
What are your current pain levels?
What is your current sleep quality?
What is your current diet like?
What is your current level of physical activity?
What are your current mental health status?
What is your name?
What is your phone number?
What is your email address?
What is your date of birth?
Are you pregnant?
Do you have any surgical scars?
Do you have any other skin conditions?
What is your smoking status?
What is your alcohol consumption status?
What is your caffeine consumption status?
What is your drug use status?
What is your sexual activity status?