I am experiencing a low risk/high risk (circle one) pregnancy according to my doctor/midwife. If I am currently having or develop complications (any conditions/symptoms listed above) I will discuss the condtion with my massage therapist and will have a medical release for bodywork signed by my prenatal care before continuing bodywork.
I have completed this health form to the best of my knowledge. I understand that Bodywork is a health aid and does not take the place of a physician's care. Any information exchanged during a Massage or Bodywork session is confidential and is only used to provide you with the best health care services.
If I am not able to make scheduled appointment, I agree to cancel the appointment 24 hours in advance. If I miss a scheduled appointment without giving 24 hour notice, I agree to pay any missed appointment charge.
I am responsible to pay for any Massage or Bodywork fees not paid by my insurance company.