Indian Head Massage

Indian Head Massage

Client Intake
Name

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Phone Number
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Have you ever had an Indian head massage?

YesNo
Are you on any medications or medical treatments that might impact this treatment?

YesNo
If yes, please describe:
I understand that massage is for the purpose of stress reduction, relief from muscular tension or spasm, or for increasing circulation. I understand that the practitioner does not diagnose illness, disease or any other physical or mental disorder.

The practitioner does not prescribe medical treatment nor perfom spinal manipulations. I will inform the practitioner of my current condition at the time of each visit.
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