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  • Customized Therapeutic Massage Intake Form

    Please fill out our required Health Intake Form 48 hours before your session, sooner is better!
  •      🍀 Customized Therapeutic Massage 🍀

    Our Customized Therapeutic Massage (Not a full-body massage) sessions are specifically designed to address/target persistent pain or discomfort including extreme muscle tightness—especially those resulting from past injuries or trauma that may not fully resolve with Relaxational massage session alone.

    This form is your opportunity to provide detailed information about your current discomfort, including pain history, pain patterns, intensity, trigger of pain and any factors that aggravate or relieve it.

    📄 If you have an MRI report on MyChart or any relevant medical documentation, uploading it is greatly appreciated and make our communication process more efficient in guiding appropriate treatment.

     

    Some common concerns (area) we can help with include:

    • Headaches
    • Neck pain/stiffness
    • Shoulder pain (including rotator cuff issues)
    • Upper/Middle back pain around the shoulder blades
    • Whiplash from the past auto accidents
    • Symptoms of TOS (Thoracic Outlet Syndrome) or Carpal Tunnel
    • Pain around Forearm, Elbow pain (Golfer’s or Tennis elbow)
    • Lower back pain
    • Hip pain
    • Sciatica
    • Foot pain (like plantar fasciitis) or recurring ankle sprains
    • Pregnancy massage (side-lying, after the first trimester)
    • Post-surgery massage (6-8 months after surgery, with your doctor’s permission)
      *Please Note: We are not providing the groin pain / Adductor pull pain for male clients, we refer you out to other trusted professionals if you have this needs.

    ⏰Session length⏰:

    Below are just general guidance. I will follow up with you via text after you submit this form which session length to choose for your specific condition.  

    ⏰ 30-minutes for ONE specific area. This is the shortest service time. 

    ⏰ 60-minutes for ONE-TWO area of concern.
    Note: Let's say you have very tight Neck (from bottom of the scull/ Neck/ top of the shoulder where neck meets), Choose 60 minutes. Or You may need to consider 90 minutes for stiff Neck & stiff Upper/Mid back between the shoulder blades. If you have pain on Shoulder blades & top of the arm bone, you may need 60 minutes for that alone. 
     
    If you want add lower back pain treatment added, then add another 30 minutes is the shortest for it if it is just lower back issue, sometimes lower back pain comes from tight front side muscle. In this case, you need 60 minutes or longer to treat front & back for proper lower back pain mitigation.

    ⌛Less time you choose, less points to sink into deeper when it comes to Deep tissue approach due to the time restriction. Just keep this in mind.

    ⌛ Believe it or not, clients dealing with chronic conditions often find themselves saying, “I need more time!” after 90 minutes or longer session.
    That’s because working into deeper layers of muscle tissue—especially with a focused, therapeutic approach—takes time to be effective. The body needs time to soften, release, and respond. Many clients are surprised at how quickly the session goes by once we start addressing those deeper layers.

    Longer sessions not only allow for more effective work but also help create lasting results for chronic pain, tension, or structural imbalances.


    Your session will be customized just for you, using a variety of techniques, tools to release tension, not only bring more nutrient into the tissue by increasing the blood circulation, it can address connective tissue (fascia) and more deeper layers of tissues (so that you get adjusted easier at Chiropractic care), or promote re-organizing the scar tissues that are torn or buit up by past surgeries or injuries to speed up the recovery and help your body feel better faster!  In real world, the work place injuries by overusing muscles are very common, and it can be prolonging than it should be without proper treatment methods, sometimes, you may have to consider invasive medical procedure if it is not cared properly.

     

      

    ⚘ Your level of pain tolerance & sensitivity ⚘

    Your therapist does not rely solely on statements like “I have a high pain tolerance.” Instead, they carefully observe and respond to your real-time physical reactions during hands-on work. Pressure is always adjusted based on what your body communicates in the moment—not just what you say you can handle.

    This ensures the session remains safe, effective, and supportive of your body’s natural healing process.

     

    What Modalities Does the Therapist Use?

     

    if you want to just jump right into fill out the form to submit, feel free to keep scrolling down. If you wish to come back to read this section, you can access latest version of this intake form from our website "Our Services" section anytime!

     

    Your therapist will draw from a range of techniques tailored to your needs, which may include:

    - American version Swedish Massage & Stretching & Joint Mobilization
    - Deep Tissue Massage including Trigger Point Therapy, Myofascial Release (may use Gua Sha stone with oil as needed)

    🍀 American-Style Swedish Massage
    At Aira Massage Wellness KY, we use the American version of Swedish Massage, which differs significantly from the traditional European interpretation often refers to a very light, feather-touch technique which is ideal for senior citizens who have less body circulation.— the American-style Swedish Massage is what most U.S. clients recognize as a gentle to medium-pressure therapeutic massageit emphasizes intuitive flow, therapeutic intent, and integration with clinical assessment. While it forms the core of our Relaxational Massage sessions, elements of this technique are woven into every treatment we offer.

    This approach is more dynamic and versatile than deep tissue massage. It features a faster pace, and the time spent sinking into the tissue is shorter, allowing the therapist to cover broader areas of the body within a session —while still providing therapeutic benefits in a soothing and approachable way..

    This style combines several core techniques, including:

    ❀Gliding strokes (Effleurage)
    ❀Kneading strokes (Petrissage)
    ❀Friction strokes
    ❀Tapotement (Percussive techniques), Vibrations, 
    ❀Joint mobilizations 
    ❀Stretching (Passive, assisted/resisted, AIS, PNF)

    🍀Sports Massage

    It is using lighter-pressure & faster paced massage using Swedish Massage techiniques mainly used for pre-competition or between.

    🍀Deep Tissue approach

    Deep Tissue Massage involves an extra-slow, deliberate approach—beginning with warming up the tissues and gradually sinking into the deeper layers of muscle. This technique also incorporates elements of Trigger Point Therapy, and Myofascial Release to effectively address chronic tension, muscle adhesions, and restricted mobility. It is better to avoid this type of massage if you have coming up sports competition unless you are ok with it.

    It’s not just about how much pressure is used—it’s about how the pressure is applied. Precision, pacing, and responsiveness to your body’s feedback are what make this work truly therapeutic. so, tell your therapist "right there!" when you find the great spot to sink in deeper.

     

    🍀Trigger Point Therapy (TP)
    Trigger points are areas of muscle tissue in a hyperreactive state. If left untreated, they can cause local or referred pain—pain that may travel upward, downward, or radiate to other areas when pressure is applied.

    You can refer to general Trigger Point (TP) charts online to see typical referral patterns, but keep in mind that trigger point locations and referral responses vary from person to person. Some clients instantly recognize the referral sensation—“Oh, that goes up to my temple!”—while others experience more subtle responses that may require deeper or sustained pressure to detect. 

    During a session, your therapist will glide along the taut band of muscle multiple times, gradually increasing pressure up to approximately 30 lbs. This can feel like a quick “sink in” or a slow, deliberate entry where the referral pain becomes noticeable. Please communicate your preference of location & pressure level as therapist increasing the pressure. Communication is essential!!

    Clients may also experience unexpected reactions from TP Therapy such as deep relaxation, drooling, goose bumps, or intense drowsiness—all normal physiological responses to this focused release work. Many report significant pain relief and a deep sense of calm after the session.

     

    🍀Myofascial Release Therapy
    Also known as Connective Tissue therapy, Myofascial Release focuses on loosening restricted or adhered fascia—the thin connective tissue that surrounds muscles and organs.

    When fascia becomes hardened or stuck, it can trap nerve endings, leading to discomfort or limiting your range of motion. This technique involves skin rolling, gentle lifting, and slow pulling of the tissue, typically with little or no massage oil, to create a traction effect and release restrictions.

    This approach is subtle yet highly effective, and it plays an important role in restoring tissue mobility and reducing nerve-related discomfort.

     

    🍀Other: Therapist may use Guasha stone with oil for connective tissue release work, or partial Shiatsu tequnieue to release Trigger Point.

      


     We’re looking forward to working with you to create meaningful, lasting results☺

     

  • 💡 To submit this form properly, each fields are required to fill out.  If you see some area is not applicable to you, just put 'NA' or choose appropriate answer from pull-down menu  to complete submission. Due for submition is 48 hrs prior to your session date. 

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  • the Main symptom of your pain/discomfort 

  • the Main area of your pain/discomfort 

  • Type of discomfort or pain and Most painful time?

  • Movement Restrictions

    Any chores you usually do became harder to do? *If you have any Joint Replaced, we are not doing the joint movement or massage right on that area unfortunately since it is out of our scope to treat, please consult your Dr. and Physical Therapist for further assistance for specific recovery care. What we can is to loosen up the surrounding area of muscles.
  • For your main pain/discomfort, did you get an Motor Vehicle Accident in the past?

    *Please wait at least 72 hours for making massage appointment from the date of the incident* If you got in an accident and experiencing Whiplash effect, please explain below.
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