Are you taking any medication? *
Are you currently pregnant? *
Do you suffer from chronic pain? *
Do you have any injuries?
Please indicate any of these conditions that apply to you:*
Have you ever received a professional massage before?*
What type of massage are you seeking?
What type of pressure do you prefer?
Do you have any allergies or sensitivities?
Please select any areas of discomfort or tenderness:*
I have completed this form to the best of my ability, and I agree to inform my therapist if any of the above information changes.
