Whole Health Massage - Terms & Conditions

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Terms & Conditions:
I understand that massage therapy should not be used as a replacement for other forms of health care and that the therapists at Whole Health Massage are not in the business of diagnosis. I also know that in some cases the therapists may refer me to another health care practitioner as they may feel is necessary for my best interests. I realize that if I do not give pertinent information regarding my health the therapist may not know the best form of treatment to take and that in some cases my well-being may be at risk.

I acknowledge that my therapist has given me an appointment time which is for me: if I do not call to cancel in plenty of time's notice, that appointment time may not be given to another client so I may be charged if not given 24 hours prior to time scheduled.

Initial here to acknowledge you have read & understand the above terms & conditions:

Intake Form:

First Name:		Street:
Last Name:		City:
Email:		State:
Home Phone:		Zip:
Work Phone:		Date of Birth:
Cell Phone:
Employer:
Job Title/ Description:

Injuries:
Medical Conditions:
What do you hope to gain from massage?
How often have you received professional massage therapy?
What areas do you hold most of your stress?
What repetitive motions do you preform at work or in athletics?
May we confer with your other health professionals? Is so, please list their names and numbers:
What type(s) of massage do you know you like (or not care for)?
Is there anything else you would like to share?
	To send, click the Submit button once when complete.

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