• Massage Intake Form

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  • Have you ever had a professional massage

  • Do you have difficulty lying on your,
  • Do you have any allergies to,
  • Do you have sensitive skin?
  • Are you wearing,
  • Do you sit for long hours at a,
  • Do you perform any repetitive motion in,

  • If you experience stress in your daily life, how do you think it has effected your health?

  • Is there a particular area of the body where you are experiencing tension, stiffness, pain, or other discomfort?

  • Do you have any goals in mind for this massage session?

  • What type of pressure do you prefer?
  • Do you have any hormonal implants? (i.e. birth control implant, hormone pellets)

  • Are you currently under any medical supervision?

  • Do you see a chiropractor?

  • Are you taking any medications?

  • Please check any condition listed below that applies to you:

  • Draping will be used during the session- only the area being worked on will be uncovered. Clients the age of 17 must be accompanied by a parent or legal guardian during the entire session. Informed written consent must be provided by parent or legal guardian for any client under the age of 17.

    I understand that the massage i receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort i will immediately inform the therapist so that the pressure may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnoses, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment that I am aware of. I understand that massage therapists are not qualified to perform spinal or skeletal adjustments, diagnose, or treat any physical or mental illness, and that nothing said during the session should be construed as such.

    In order for our schedule to run smoothly and accommodate our clients, we ask that you recognize the following policies.

    Appointment Cancellation Policy:

    A late cancellation is defined as any appointment canceled within the 24-hour window prior to the start time of the appointment.

    A no show is defined as any appointment that is not canceled and the client does not attend their appointment.

    A late cancellation will be sent an invoice of half the price of the service to the email address on file, to be paid prior to booking your next appointment.

    A no show will be sent an invoice of the full price of the service to the email on file, to be paid before booking your next appointment.

    If you have an unavoidable emergency please contact us by email as early as possible.

    If you are late to an appointment, the missed time will be deducted from your service time. (Please Note: If you are more than 15 minutes late, your appointment will need to be rescheduled.

    Due to the nature of our services, we do ask that guests and children do not accompany you to your appointments.

    Please be advised we are requiring face masks at this time

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