• Massage Therapy Client intake Form

    All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent. You may choose to skip answering any question you feel impinges on personal information you do not wish to disclose. 

  • History History

  • Please tick if you had, or are suffering from any of the following conditions:

  • I authorize this massage spa clinic/center to perform the treatment or necessary procedure for my child.


    I authorize the use of lotion, oil, and ointments to my body.


    I acknowledge that I have consulted a physician before undergoing this massage treatment. I understand that I should consult my doctor before the procedure.


    I understand that this is an alternative treatment and if there are any medical concerns, I need to talk to my physician.


    I acknowledge that this massage therapy has no sexual intent and touching the therapist is strictly prohibited.


    I release this massage spa clinic/center for any responsibility in case of an accident, illness, or injury.


    I acknowledge that all information I provided int his form is true and accurate.

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