• Elle Marie Spa

    Massage + Prenatal Massage Intake Form
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  • Your History


  • For our pregnant guests,

    Please read carefully.
  • PRENATAL MASSAGE RISKS & BENEFITS
    Prenatal Massage Therapy Benefits - There are several observed or identified potential

    benefits to massage therapy during pregnancy, including:

    Relieves muscular tension, especially in the lower back, upper back, shoulders and neck
    Reduces stress on weight-bearing joints
    Enhances body awareness for better posture and less discomfort

    Assists with body mechanics and movement during structural change Supports birth process by relaxing muscles involved in labor and birth Eases anxiety and stress during time of transition
    Provides emotional support and nurturance

    Prenatal Massage Therapy Contraindications – Performing massage therapy during pregnancy is contraindicated for women experiencing any of the following symptoms/signs:

    Bloody discharge
    Continual abdominal pains
    Sudden gush or leakage of amniotic fluid
    Sudden, rapid weight gain
    Increased blood pressure
    Protein or sugar in urine
    Severe back pain that does not subside with change in position Visual disturbances
    Severe nausea and/or vomiting (cannot keep anything down) Severe headaches
    Excessive hunger and thirst
    Increased urination in the second trimester
    Fever
    Diarrhea
    Excessive swelling in arms or legs
    Decrease in fetal movement over a 24-hour period

    Additional conditions – phlebitis, thrombosis, or suspected clotting conditions, any kidney, liver or spleen compromise or infection. Local massage on areas with severe varicose veins and swelling are avoided due to clotting risk.

    Prenatal High-Risk Pregnancies

    It is a strict policy of Beyond Exercise to require a doctor’s release form in order to receive massage therapy during a High-Risk Pregnancy, which includes, but is not limited to:

    Early labor, miscarriage threat, placental or cervical dysfunction Gestational Edema Proteinuria Hypertension (GEPH) Preeclampsia
    Gestational Diabetes

    Pre-existing cardiac, renal, connective tissue or liver disorders/diseases Fetal genetic disorders
    Complications in previous pregnancies
    Three or more miscarriages


  • Your Service

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  • Your Promise

  • I acknowledge that I must adhere to Elle Marie Spa's policies:

    Cancellations: We allow cancellations 24 hours prior to your appointment. Cancellations less than 24 hours will result in a 50% charge and a No Show will result in a 100% charge on your gift card or credit card.

    Check In: Please check in at least 10 minutes prior to your reservation. If you arrive late for your appointment, you risk having your appointment shortened so that we can accommodate the next scheduled guest.  

    Gratuities: The price of your service does not include gratuity. We recommend a 15% to 20% gratuity for your service provider.

    We thank you in advance for respecting these and look forward to making your day amazing!

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