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What are you looking primarily for in your massage today? Please use the diagram below to indicate areas of tension or discomfort

I would like my massage to be more: label>Smooth and Flowing..............................................Deep and Focused

My tolerance for pressure is:I am a delicated rose petal..............................................I don't feel pain

Mediacl History:Do you exercise regularly Yes No Type : Are you currently under the care of a physician? Yes No Name, phone number , and what forAre you using any medications or other substances? If yes, please list below: Please list any surgeries, accidents, Or major illnesses Please review the following list and check those conditions that have affected your health either recently or in the past:

Consent for CarePlease read the following and sign below. 1. I understand that although massage therapy can be very therapeutic,it is Not a substitute for medical examination, Diagnosis and treatment. 2. I acknowledge that massage should not be done under certain medicalonditions and i affirm that i have answered all questions pertaining to medical conditions truthfully. I Will inform my practitioner of any changes in my health status, and all important communication from other care practitioners. 3. I understand that this is a therapeutic massage and any sexual remarks or advances will terminate the session, and i will be liable for payment of the scheduled treatment. It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. Client signature Date