This questionnaire must be completed within the 24 hours prior to your massage appointment.
This form acts as a supplement, not a substitution, to the Client Health & Information Form, which must be completed prior to a client's first visit.
An accurate and updated report of your health history at each visit is important to ensure that it is safe for you to receive a Massage Therapy treatment. If you have a specific medical condition or specific symptoms, Massage Therapy may be contraindicated. In specific instances, a referral from your primary care provider may be required prior to your Massage Therapy session. All information gathered for your treatment is confidential except as required by law. Written authorization will be required for the release of any information.
New Location as of May 24, 2021:
2305 Commonwealth Drive, Charlottesville, VA 22901