Health History

Have you had a professional massage before?

Add your text

Are you taking any medications? If so, please list.

Have you had any major surgeries? If yes, please list.

Do you have any allergies? If so, please list.

Are you pregnant?

Do you have any of the following conditions?

Reason for massage therapy visit?

What type of pressure do you prefer?

By submitting this form, I acknowledge that I am aware of the benefits and risks of massage therapy and that I have completed this form to the best of my knowledge. I also agree to inform my massage therapist of any health or medical changes.