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.

Get in Touch

352.702.1420

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.

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