Mobile Massage Therapy Intake Form

Please fill out this client intake form so that we may fully understand your needs before you begin your massage session.
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As massage therapists, we're all ethically bound to adhere to the principle of confidentiality. We agree to do that as members of professional associations like Associated Bodywork & Massage Professionals.

It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage.

 I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. 

I understand that my personal health information will be collected. I understand that all information that I provide will be kept confidential unless required by law. 

I understand and consent that any information will not be shared to various care providers not involved in my care and treatment. I understand that it is my responsibility to confirm the exact details of my coverage.