• Myo - Muscle Pain Treatments & Blood Flow Restoration Myo Therapy; Myo Therapy Massage; Intake Form

    All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent.

  • Please pick one.*
  • Format: (000) 000-0000.
  • Todays date*
     - -
  • Date of Birth*
     - -
  • The name of the voucher you purchased*
  • How did you find our business.*

  • All Add ons are free (Please pick the ones you want)*
  • Favorite Aroma Therapy

  • Which Type of muscle pain removal you wanting. (Read Carefully)*

  • Massage Policies:

    Client services and chart information are confidential. Written authorization is required from you to release any information.

           • You can keep your phone ringer on if you want - it's ok with us.

           • You can be late and reschedule as often as you want, no problem (This is a no stress business) 

           • You may disrobe to your comfort level, 100% nude under the covers is best for both customer and therapist. (may disrobe to your comfort level) in relaxation therapy only

           • I understand that my Myo & Relaxation therapist or I may end the session at any time for any reason 

    Client Agreement:

    I understand that therapeutic MYO therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals.

    I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service.

    It is my choice to receive therapeutic MYO treatments as a form of therapy.

    I understand that treatment given is designed to address myo / muscle pain and stress.

    I also undersand that if at any time I feel discomfort during the session, I will immediately inform the Myo therapist so they adjust the pressure.

    I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status.

    I understand that my failure to do so may post a threat to my health and/physical well being and I hold harmless Myo therapist from any liability whatsoever arising from failure on my part.

    By my electronic signature below, I agree to the massage policy and client agreement above. 

  • Myo therapy: Muscle pain removal, a physical therapy treatment, to solve Muscle pain.*
  • What do you do the most all day?*
  • Relaxation Myo therapy: A quite treatment designed to help you sleep; clear the mind and help you recover from a challenging lifestyle.*
  • How do you sleep?*
  • Did you know this information?*
  • I want to lower my future price for relaxation massage therapy and muscle pain removal.*
  • Do you have a groupon voucher for myo muscle pain removal treatments?*
  • Do you have high pain tolerance?
  • Which are you more (#1)?*
  • Pick one*
  • Sign me up for price discounts. Of $40 - 60 a treatment.*
  • Do you have trouble sleeping or staying asleep?
  • Your location will be.
  • Which of these apply to you?*
  • The type of Groupon treatment that I purchased is.*
  • What do you want more? (#2)*
  • What is your occupation?*

  • Are you taking any Medications?*

  • Which of these apply to you?*
  • What hurts on your body most of the time?*

  • What areas do you want most time of the time spent on?*
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  • In the myo therapy pain removal; the plan is listed below #3.*
  • In Relaxation myo therapy massage; the plans are listed below. #4*
  • Explanation of our business; Relaxation myo therapy and Muscle pain removal Myo Therapy.*
  • Reload
  • Should be Empty: