Healthform

(Returning Client)

Hi! Thanks for booking with me again 🙂

Here is a (shorter) Form for you. The goal to fill in these forms is to include updates that might have occurred since previous appointment, on your physical and emotional health. It is a Consent form as well.

Name *

Email *

How are you feeling at the moment?

• Excellent
• Good
• Fair
• Poor

Activities and frequencies / Have you been stretching-foam rolling?

what are your Goals for this session? + Parts of your body needing attention *

What kind of touch/ pressure will you prefer? *SoftMediumDeepVery Deep

Massage length

• 60mn
• 90mn
• 2h
• 2.5h

Anything else you would like to share?

Preferred Essential oils for this session

• None / no scents pl
• Lavender
• Mint
• Eucalyptus
• Jasmin
• Rose

Location ?

• Home-studio Oakland
• Mobile massage

Please enter the location.

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

I have completed this form to the best of my knowledge and will inform the massage therapist of any change in my physical health.

• I agree

I understand that the massage I receive is provided for the basic purpose of relaxation, stress reduction and relief of muscular tension. If I experience any discomfort, I will inform the practitioner so that the pressure may be adjusted to my level of comfort. I_understand that all information that I provide will be kept confidential. I am aware of the benefits and risks and give my consent for massage.

• I agree

• I agree

Signature

Name

Submit