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Intake Form

What is your lifestyle and job? Describe how you use your body on a daily basis.

Are their any injuries or health concerns that need to be addressed? OR

Repeat clients - have there been any new injuries or health concerns since your last session?

On average how much water in ounces do you drink on a daily basis?

Do you have any sensativities or allergies to lotions, oils, scents, or materials?

Who should I contact in case of an emergency? Please list 1-2 names & phone #'s - Thank you!

Pregnant Clients Only:

 

Disclaimer: I completely release my session facilitator from any liability that may arise as a part of my session. I understand that my massage therapist will not diagnose conditions nor prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that massage does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional and be advised I may experience a pregnancy massage prior to scheduling a session.

Reiki Healing & Crystal Therapy Clients Only

Disclaimer: I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological aliment I may have.

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