• INTAKE FORM REMEDIAL MASSAGE

    INTAKE FORM REMEDIAL MASSAGE

    Serenity Wellness Massage Toowong
  •  - -


  • MEDICAL INFORMATION

    Please fill in your medical and relevant details.





  • *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

    Fill in this section to personalise your massage and "SIGN" the agreement.




  • Parent/Guardian Authorisation (for clients under 18 years of age)

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

  • Client Agreement:
    I, {fullName3} 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.

  • Clear
  • Image-106
  • Should be Empty: