New client intake appointment request

Theraputic mobile massage by Melissa Fernandez MA93231

New client intake form
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To request an appointment please fill in your details and I will confirm with you. 60 min massage $140. 90 min for $170. Additional massage time is 1$ per min. 📲346.282.1006 MA93231-Florida, MT 126110- Texas
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I realize that I, the client, am responsible for keeping my massage therapist informed of any condition or health issue that may affect this bodywork session. The information shared on this form and during each session is kept confidential between the therapist and myself. I, the client, understand that massage is a form of health and wellness maintenance, which may facilitate various types of healing, however, is not intended to replace medical treatment if otherwise necessary.

I provide non-sexual massage only. Do not contact me for non therapeutic services.

I understand and agree to the terms above.
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Theraputic mobile massage by Melissa Fernandez MA93231