Client Intake Form
The information collected in this form will be used only for the purpose of designing an appropriate massage therapy program for you and will not be disclosed to any third party without your consent.
General Information
In case of emergency, please notify:
Massage Information
Medical Information
By signing below, you agree to the following: I have completed this form to the best of my ability and knowledge and agree to inform my Massage Therapist if any of the above information changes at any time.
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