Prenatal Health Intake Form

If you are pregnant, please complete the following health intake form prior to your first appointment. You may also need to have your doctor complete and sign our Medical Release and bring it with you to your first appointment. Your information is used only for the purpose of ensuring the safest and most effective massage experience for you, and is held in strictest confidence.

Online Submission

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

  • 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 I may also be required to have a medical release signed by my health care provider.
  • Cancellation/late arrival policies: 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. (Should you have a medical emergency that prevents you from keeping your scheduled appointment, this policy will be waived.)
  • The therapist also reserves the right to refuse service to anyone for any reason.

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