New Client Intake Form

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I consent to hands on, therapeutic body work. I agree and understand that massage therapy is for the purpose of relaxation and alleviation of muscle soreness.

Massage is not a substitute for medical, physical, emotional diagnosis, and treatment.

I have discussed my preferences, injuries, accidents, and medication with my massage therapist and will inform them during the session if pressure or temperature need to be adjusted.

I agree that massage therapy is non-sexual and any inappropriate contact or dialogue will lead to immediate termination of the session with full payment due.

I agree that if I am sick or not feeling well I will reschedule my session for a later date. I agree to not hold Megan OConnor liable or sue her if I contract Covid-19 or any other illness or injury following a massage session.

Updated: 3/04/2024

Email *

Name *

Preferred Identity *

She/ Her/ Hers

He/ Him/ His

They/Their/Them

Other:

Date of Birth *

YYYY

Phone Number *

Address *

Occupation/ Physical Activities/ Hobbies *

Any Medical Conditions/ Surgeries/ Medications that would affect/ be affected by bodywork? *

Do you have experience with massage? What have you liked or would have changed about past experiences? *

Do you have any pets in your home? If yes, what type? *

What specific problem areas would you like focused on this session? *

What are your goals for receiving massage therapy treatments? *

Have you been sick or are currently taking any medications or antibiotics? *

Any thing else I should know/ be aware of? *

Sign and Date *

How did you hear about me?

Send me a copy of my responses.

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