Massage Intake Form

 

Personal Information

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Medical Information


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Massage Information


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Clients can sign the waiver form on arrival

By signing below you agree to the following.
I have completed this form to the best of my ability and knowledge and agree to inform my therapist if any of the above information changes at any time.

 

Date

 

 

 Client Signature

 

  

Therapist Signature

 

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Karenelwes

© Karen Elwes. All rights reserved.