Prenatal New Client Intake Form

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I consent to hands on 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.

Eventhough prenatal massage is perfectly safe during all trimesters, some things are out of the practicioner's control. I agree to not hold Megan OConnor liable or sue her if I contract Covid-19, any other illness, or miscarry following a massage session.

Updated: 03/04/2024

Email *

Name *

Date of Birth *

YYYY

Phone Number *

Session Address *

Occupation/Physical Activities/Hobbies *

Current Week of Pregnancy *

Any Complications, Problems, High-Risk Factors, Infections, and/or Medical Conditions? *

What pain or discomforts would you like to address today? *

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

Do you have experience with massage and prenatal massages? What have you liked or disliked about past experiences? *

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

Anything else I should be aware of or know about? *

How did you hear about me? *

Sign and Date *

Send me a copy of my responses.

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