Massage Intake Form: fill in only the first time you make an appointment

• 48+ Hours notice: No charge
• 24 – 48 Hours notice: 50% of massage fee charged
• Less then 24 Hours notice: No refund

Thank you for understanding the charges, since I may not be able to fill in your space.

By sending this form, I confirm that I have answered all questions truthfully and will inform my massage therapist of any changes to my health. I understand that this massage therapy is for relaxation and muscle tension reduction, not a substitute for medical examination, diagnosis or treatment. I will immediately inform the therapist if I experience any pain or discomfort during the session.