Chair Massage Intake Form
1600 West Eau Gallie Blvd Ste 203
(321) 987-0041
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First Name *
Last Name *
Email *
Phone Number *
I agree to the following: *
Yes
I am physically capable of getting on and off the massage chair safely.
I do not have any injuries or conditions that should prevent me from receiving massage therapy and have not been told by a physician that I should not receive massage therapy.
I understand that massage therapy is not a substitute for medical care.
I will be truthful with my therapist about all medical conditions I may have.
I will report any discomfort or pain to my therapist during the massage.
I understand that massage is for relaxation and therapeutic purposes only.
I understand that any inappropriate behavior will result in refusal of service.
I release my therapist and The Deep Tissue Spa from all liability concerning any injury or damages that may occur during or after my massage
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