New Client Intake

Please answer the questions below before your first appointment so I may be better prepared.

First name

Medical History

Anything Else

It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status.

Last name

Phone

Allergies

Doula Notice! The therapist is also a working doula and may need to cancel or reschedule an appointment to attend a birth. They will attempt to give you as much notice as possible. Check to say you agree.