Client Intake Form

  • 1Personal Information
  • 2Massage Experience
  • 3Current Health
  • 4Health History
  • 5Agreement

Step 1: Personal Information

Step 2: Massage Experience

Step 3: Current Health

Step 4: Health History

Step 5: Agreement

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 understand that there is no implied or state 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 state all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. I will participate fully as a member of my healthcare team. I will make sound choices regarding my sessions' plan based upon the information provided by my massage therapist. I agree to participate in my own self-care programs and adhere to the plan we select. 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 elective treatment to the best of his or her skills and knowledge.

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605 W. Magnolia St.
Leesburg, FL 34748

MA 45897/MM 18595

For directions, please click on the button below.

Free street parking available for your convenience.

Leesburg Office Directions

4390 N Federal Hwy Suite 210
Fort Lauderdale FL 33308

MM 41248

For directions, please click on the button below.

Ft. Lauderdale Office Directions

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