3 minutes to complete
The individual must be 18 years of age or above. The individual must not be suffering from any major health problem. The individual must not be suffering from any contagious or infectious disease. The individual must not be pregnant. The individual must not be suffering from any mental disability. The individual must not be under the influence of alcohol or any other intoxicating substance.
Do you have any physical ailments, injuries, or conditions that we should know about?
If so, please describe:
Do you have any allergies or sensitivities?
If so, please describe:
Do you have any medical conditions or are taking any medications that we should know about?
If so, please describe:
Do you have any mental or emotional conditions that we should know about?
If so, please describe:
What is the primary reason you are seeking massage therapy at this time?
What are your expectations from this massage therapy?
What are your goals for massage therapy?
What other health care providers (e.g., doctor, chiropractor, etc.) are you currently seeing for this reason?
If you consent to get this massage done. Please sign below.