Body Therapy Intake Waiver Form
The following information is required for your safety and to benefit your health. Whilst bodytherapy is totally safe when administered professionally by a qualified body therapist, there are certain contraindications that require special attention. It may be necessary for you to consult your GP or specialist before any body therapy treatment can be given. Please fill this form out the best you can. You will also have a brief personal consultation with Laraba prior to your treatment. You are not required to fill this out before each session.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
Social media handle (ex: @balanced.healing):
Do you have any known allergies?
How do you enjoy spending your free time?
Are you pregnant or nursing?
Current medical conditions like Asthma, Diabetes, Heart problems, Kidneyproblems, migraines, epilepsy, scoliosis, communicable disease, etc.?
Stress levels between 1-10 (10 is very bad), and how stress manifests for you?
Is there anything important for Laraba to know about that will support your treatment?
Signature
*
Submit
Should be Empty: