MASSAGE CLIENT INTAKE FORM

FALLS HEALING ARTS
MASSAGE CLIENT INTAKE FORM

Please fill out and submit prior to your first appointment. 

If you haven't already, give us a call to schedule your first appointment. 

(By submitting an intake form online without calling us,

does not guarantee the fastest response back to you for scheduling.) 

The information on these forms help our doctors and therapists determine what course of treatment to pursue.

CLIENT INTAKE FORM

If you have any recent or chronic medical conditions, please check them below and discuss them with your massage therapist. 


Have you had or do you have any of the following:


Please read before signing: 


I understand that the purpose of this massage is for stress reduction, relief from muscular tension or spasm, or for increasing circulation.  I understand that the massage therapist does not diagnose illness, disease, or any other physical or mental disorder.  As such, the massage therapist does not prescribe medical treatment or pharmaceuticals.  This massage session is not a substitute for medical examinations and/or diagnosis. It is recommended that I see a physician for any physical ailment that I have.  I understand that massage therapists need to be aware of existing physical conditions; therefore, I have stated all of my known medical conditions and take it upon myself to keep the massage therapist updated on my physical health.  

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