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  • New Client Intake Form

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  • General Medical History Information


  • General Lifestyle Information

  • Areas of Active Pain or Concern

    If you have chronic pain areas/injuries (existing longer than 3 months), please make note of that below.
  • Sensory & Overall Comfort Needs


  • Therapeutic Massage Waiver Form

  • Please take a moment to read & digitally initial all of the following statements:

    • If I experience pain or discomfort of any kind during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort.  I recognize that it is my responsibilty to communicate with my therapist my needs & expectations; I will not hold my therapist responsible for any pain or discomfort during or after the session.

    • I understand that the services offered today are intended to be in support of medical care; I understand the services are not a subsitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, perscribe, or treat physical or mental illness.

    • I affirm I have notified my therapist of all known medical conditions, emotional/mental conditions, and PTSD triggers, injuries (past/present), and (past/present) surgeries.

    • I agree to inform my therapist of any changes in my health and medical conditions, emotional/mental conditions, and PTSD triggers, injuries (past/present), and (past/present) surgeries  I understand that there shall be no liability on my therapist's part should I forget to do so.

    • I understand that massage is entirely therapeutic and non-sexual in nature.

    • By signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future, relating to massage therapy, bodywork, emotional distress related to pre-existing mental/emotional disorders .


    • CANCELLATION POLICY
      I understand that, should I cancel an appointment less than 24 hours before the scheduled time or "no show" for an appointment, I will be charged full price of the session booked.  If the appointment was booked with a gift certificate, it will be voided in lieu of the fee.
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