2 minutes to complete
The eligibility criteria for the prenatal massage intake form are- the person who is willing to get a prenatal massage must be pregnant, the person must be 18 years old, and the person must not have any type of medical complications like diabetes or high blood pressure, the person must not have any type of infection in the body.
Name
Address
Phone number
Pregnancy Due date
Primary care physician
Are you comfortable with any gender of your massage therapist?
Do you have any areas of pain or discomfort?
Do you have any allergies or sensitivities?
Are you experiencing any nausea or vomiting?
Do you have any medical conditions?
Do you take any medication?
Do you have any questions or concerns?