• INTAKE FORM REMEDIAL MASSAGE

    INTAKE FORM REMEDIAL MASSAGE

    Serenity Wellness Massage Toowong
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  • MEDICAL INFORMATION

    Please provide your medical and other relevant information





  • *We will refuse to offer massage to a woman who is still in her first trimester (12weeks), because of the increased risk for miscarriage associated. 


  • MASSAGE INFORMATION

    Please complete this section to guide the personalisation of your massage treatment, Sign and Submit the client agreement




  • ONLY - Clients under the age of 18

    I, , am the parent/legal guardian of give permission for my child to receive massage therapy at Serenity Wellness Remedial Thai Massage.

  • Client Agreement:
    I understand that massage therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization. I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service. It is my choice to receive massage as a form of therapy. I also undersand that at any time I feel pain or discomfort during the session, I will immediately inform my massage therapist so they adjust. I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status. I acknowledge that there may be post-treatment effects including muscle soreness. I understand that my failure to do so may post a threat to my health and/physical well being and I hold harmless my massage therapist from any liability whatsoever arising from failure on my part.
    By my electronic signature below, I have completed this form to the best of my ability and knowedge and agree to the massage policy and client agreement above.

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  • Thank you for completing this form to guide how your massage session will be personalised. Your business is greatly appreciated

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