Health Intake Form

Before we can provide your first massage, we require that you complete our health intake form. Your information is used only for the purpose of ensuring the best possible massage experience for you, and is held in strictest confidence.

Online Submission

By submitting the form below, you agree to the following:

  • I understand that massage or bodywork should not be construed as a substitute for medical treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment.
  • I understand that massage/bodywork therapists are not qualified to perform spinal or skeletal adjustments, diagnose, or prescribe for any physical or mental illness, and that nothing said in the course of the session given should be construed as such.
  • Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile prior to any future sessions and understand that there shall be no liability on the therapist’s part should I fail to do so.
  • I understand that any illicit or sexually suggestive remarks or advances made toward the practitioner will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.
  • No-show or cancellation within 24 hours of a scheduled massage will result in charge of the full price of my intended session. Missed or late cancellation will void my gift certificate if being used for payment. Late arrival will shorten my session accordingly, with the full payment due.
  • The therapist also reserves the right to refuse service to anyone for any reason.


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