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Client Intake

To ensure you get the most out of your appointment, we kindly ask that you complete your intake form before you arrive. Filling out the form in advance allows us to maximize your hands-on session time and tailor the treatment specifically to your needs.

Birthday
Month
Day
Year

Must be 18+ yrs old

Multi-line address
Have you had a massage before?

Other: Yes but not medical/professional. This includes spa ("Fluff") & spouse massages

Please include whether it's the Right or Left side of the body.

Ex: Right shoulder (Deltoid), Right Hip (Glute), Right Foot (Unsure where)

  • While it is not necessary to identify the specific muscle, providing as much detail as possible about the location of your discomfort will enable me to deliver the most effective care.

When did the discomfort start?
Do you have any allergies?

This would not include mild seasonal allergies. The purpose of this question is for anaphylactic shock or severe swelling.

Have you had any broken bones in the last 2 years?
Have you had any Surgeries in the last 2 years?
Are you currently on any medication for any heart, lung or circulatory problems?

This includes but not limited to any medications for Heart Disease, Blood Clots, Lung Cancer. etc.

Are you currently on any steroids?

This includes hormone replacement, birth control, cortisone, corticosteriod

Steroid Application

Upload any relevant health information or medical documents that may assist in providing you with the best possible care.

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