Ashley Masters Healing Arts

Full Name

Date of Birth

Date

Phone Number

Email Address

example@example.com

Address

Emergency Contact (Name & Phone)

Is this your first massage with us?

YesNo

Where did you hear about my practice?

Are there any specific areas youd like focus on

Are There any areas you'd like avoided?

What are your goals or intentions for this session

Do you Prefer A Heated Table?

YesNo

Is This Your Quiet Time?

Yes, SSSHHHHH!I'm open to light conversationNo, I like to talk

Do You Have A Music Preference?

Do You Enjoy Aromatherapy?

YesNo

If yes any favorites or scents to avoid

What Level of pressure do you prefer?

LightMediumFirmDepends on area- I'll let you know

Health History

Please explain in depth

Are You Pregnant?

YesNo

Are You under a physician's care?

YesNo

If Yes please explain

Are You taking any medication?

YesNo

If yes please list

Do you have any allergies?

YesNo

If yes please list

How did you hear about my practice?

- I understand that massage therapy is intended for relaxation and therapeutic purposes and is not a medical appointment.

- I affirm that I have stated all known medical conditions and answered all questions honestly.

- I will update the practitioner if there are any changes in my health status.

- I understand that inappropriate behavior will result in immediate termination of the session.

-I understand that Ashley Masters Healing Arts has a strict 7-day reschedule and cancellation policy. Appointments canceled or rescheduled with fewer than 7 days' notice will result in loss of money paid for appointment and/or deduction from package.

- I understand that all sales are final and no refunds will be issued for services, packages, or prepaid appointments. Payment is due at time of booking.

Signature

Date