All Bodies Massage Intake Form

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Basic Information:* This field is required.You may need to scroll down. Click next when you're done with this section!
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Preferred PronounsYour gender identity matters!
They/them
She/her
He/him
Other
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How did you find me?
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Have you worked with a massage therapist before?
YESNO
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When(ish) was your last massage?Feel free to estimate!
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What are the primary reasons you are seeking massage therapy?Select all that apply
Help with an injury
Relief from chronic pain
Relaxation
Nervous system regulation
Soothing sore muscles
Support with circulation
Increased flexibility
Increased mobility
Doctor recommendation
Cause having a body is hard
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Would it be helpful if our session was trauma sensitive? If yes, we can chat in person about how best to support you feeling safe and grounded
YESNO
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What level of pressure to you tend to prefer?Of course this is subjective and we will attune together to find what works for you throughout our sessions
Deep
Medium
Light
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What levels of communication do you prefer during sessions?In the next question I'll ask about the types of communication that are helpful for you
High
Medium
Low
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What types of communication feel supportive for you during sessions?Check all the apply
Guided meditation
Check in's about pressure
Explanations of anatomy
Helping direct where/how we work
Talking about whatever
Laughing together
Receiving recommendations
Non-verbal
Not sure
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What styles/tools would you like to include in sessions?You probably haven't heard of some of these so feel free to ask me for more info when we meet! Also sessions will likely include a mix of these and not all of those you select every session, but this gives me a sense of what you prefer!
Deep tissue
Long soothing strokes
Stretching
Holding trigger points
Myofacial therapy
PNF stretches
THC or CBD cream
Massage gun
Cupping
Hot stones (added fee)
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What position(s) do you spend most of your time in?
Standing
Sitting
Laying
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Do you have any allergies to lotions?
YESNO
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Do you have any past or present injuries, surgeries, or conditions that I should know about? Ex: Car accidents, chronic pain, broken bones, cuts, bruises etc.Massage is NOT recommended for people experiencing the following: Acute (recent) injuries, contagious illness, and fever. NOTE: People should consult a doctor before receiving massage if their bodies are navigating: hypertension, blood clots, pregnancy, heart/liver/kidney conditions or cancer. Please let me know if you have been referred by a doctor!
Huge
Large
Normal
Small
Ok
Ok
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Is there anything else that might be helpful to share, or for me to be aware of that would make you feel safe and more able to relax during our work together?
Huge
Large
Normal
Small
Ok
Ok
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INFORMED CONSENT FOR MASSAGE THERAPY

The purpose of this section is clarify that you have been notified of the risks and potential benefits of massage therapy and give you the opportunity to ask any questions regarding massage therapy so that you are able to make a clear and conscious choice to engage in this work with me. It also includes my cancellation policy which is below. Please feel free to ask me any questions regarding informed consent as well as my cancellation policy.

I hereby request and consent to the performance of massage therapy by the therapist/technician named above. Massage may provide benefits of stress reduction, relief from muscular tension, spasm, or pain, as well as increased circulation. I understand that massage therapists/technicians do not diagnose illness or disease, perform any spinal manipulations, nor do they prescribe any medical treatments. I am aware that therapeutic massage is not a substitute for medical examination and I will seek health care for those services. I accept that massage promises no long-term results nor will it cure my health problems. I understand there is some risk of injury during a session or of massage having a negative impact on a previous injury.

The therapist must be made aware of all health conditions due to certain contraindications or cautions for massage. I have disclosed all such conditions. I will also update any changes to my health in future sessions.

If at any time during the massage the client or therapist/technician is uncomfortable for any reason, they will immediately say so and may terminate the session.

Sexual advances of any kind will not be tolerated.

Cancellation Policy

If you need to cancel or reschedule, I ask for as much notice as possible and require a minimum of 48 hours notification. If canceled or rescheduled within 24-48 hours of the session, I charge 50% of the session fee, and if given less than 24 hours notice I ask for the full session fee, with the exception of a documented medical emergency.
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Agree to informed consent and cancellation policy
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E-Signature
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