Before your massage treatment can begin we need to complete some paperwork.

Personal info
Legal Name *
Legal Name
Send me information about...
Mobile Phone *
Mobile Phone
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Address
Address
Birthdate *
Birthdate
Massage Experience
Have you had professional massage or bodywork before? *
What types of massage or bodywork have you received?
Current Health
Massage may not be recommended for clients with certain contagious conditions, recovering from recent injury or surgery, taking certain medications or who may be pregnant. Please share your complete medical history so that your massage therapist can ensure you are given the most effective treatment possible.
Health History
Musculoskeletal
Circulatory
Respiratory
Nervous System
Reproductive
Skin
Digestive
Psychological
Other
Client Agreement
Read the fine print below, and then "sign" on the dotted line.
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 agree to communicate with my practitioner any time I feel my well-being is being compromised. I expect my practitioner to provide safe and effective treatment to the best of his or her skills and knowledge. 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. *
We ask that you please reschedule or cancel at least 1 day before the beginning of your appointment or you may be charged a cancellation fee of 50% of the regular cost of your service. Payment may be collected automatically from the credit card on file or will be due upon receipt of invoice before your next appointment. *
Massage/bodywork is not appropriate care for infectious or contagious illness. Please cancel your appointment as soon as you are aware of an infectious or contagious condition. If it is within the 24-hour notice period, the cancellation fee may be waived. *
Appointment times are as scheduled and may not extend beyond the stated time to accommodate late arrivals. Please be on time to your appointment. *
A credit card may be required to book an appointment online. This is used only to hold the reservation in compliance with the cancellation policy. Payment is due at time of appointment. For your convenience, we accept the latest EMV chip and traditional magstripe credit cards (Visa, MasterCard, American Express, and Discover);  Pay, Google Wallet, and other contactless payment options; in-app and online web payments (Square Cash, Venmo, and PayPal); or old school cash. Promotions, discounts, and special offers may not be combined, and they may be available for a limited time only. *
Typing your first and last name between forward slashes [/] acts as your signature. For example: /John Smith/
Typing your first and last name between forward slashes [/] acts as your signature. For example: /Jane Smith/