Massage Client Intake Forms Free PDF
Client Intake Form – Therapeutic Massage Personal Information: Name Phone (Day) Phone (Eve) Address City/State/Zip email Date of Birth Occupation
Massage Intake Form - CONFIDENTIAL INFORMATION WELCOME! I would like to make your appointment as pleasant and comfortable as possible. If at any time you have questions regarding your session, please let me know.
Massage and Bodywork Intake Form Client Information Name City State Zip Date Day Phone ( ) Eve Phone ( ) Occupation Date of Birth
Massage Client Intake Form Massage Client Waiver Form Please take a moment to read and initial all of the following statements: If I experience pain or discomfort during the session, I will immediately inform my therapist so that
Associated Bodywork & Massage Professionals MEMBER Practitioner/Clinic Name: _____ Health Information Contact Information ... Client Signature: _____ Date: _____ Parent or Guardian Signature (in case of a minor ...
client agreement 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
Massage Therapy Client Health Intake Form Patient Information Name: _____ Address: _____ City: _____ State: ____ Zip: _____
that massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician other qualified medical specialist for any mental or physical ailment that I am ... Client Intake Form.doc
Client Intake Form For Massage Therapy ... The massage therapist does not prescribe medication or pharmaceuticals or perform spinal manipulation. It has been mad clear that massage therapy is a ... Parental Consent if client is under 18:
Massage & Bodywork New Patient Intake Form (Confidential Information) Date: Name: Address: Address: Emergency Contact: Phone (home): Referred by: Explain:
Indulge Spa Intake Form Name: Date: Occupation: Address: Phone: Date of Birth: ... Massage Therapists and Manicurists do not diagnose illness, disease, or physical or mental disorders, nor do they prescribe medical treatments, pharmaceuticals, or perform spinal manipulations.
Massage Intake Form Fax: ... I use sugar free products Number of servings of fruit/veggies per day ... I worry about my weight Consent 1. It is my choice to receive massage therapy. 2. I understand that massage therapy is beneficial for relaxation, relief from pain, tension, and stress.
Massage & Wellness Intake Form ... I clearly understand that massage therapy is not a substitute for a medical ... Client Name _____ Signature of Client/Guardian _____ Date Signed _____ Title: HealthIntakeForm.xls Author: Alan Created Date: 7/13/2011 4 ...
Massage therapy is not a substitute for medical examination and/or diagnosis. I affirm that I have stated all my known medical conditions and shall take it upon myself to keep my Massage Therapist updated on my ... Massage_Therapy_Intake_Form.doc Author: ebon
Pregnancy Massage Client Intake Form ... know that massage/bodywork can be harmful in some circumstances; I fully assume responsibility for receipt of massage therapy, and release and discharge the therapist from any and all claims, liabilities,
Client intake and Consent Form Date: Name: Date of Birth: Address: City: State: Zip: Home Phone: Cell: Work: Email: How did you hear about Jiva Massage Therapy?
Natural Elements Health CenterNatural Elements Health Center 900 Hwy 23 Suite 3 Milaca, MN 56353 320.983.2333 2333 Patient Massage Intake FormPatient Massage Intake Form
such, the massage therapist does not prescribe medical treatment or pharmaceuticals. This massage session is not a substitut medical examinations and/or diagnosis. ... CLIENT INTAKE FORM ___Back discomfort or injury ___neck discomfort
MASSAGE CLIENT INTAKE FORM - CONFIDENTIAL INFORMATION When complete, return it to the receptionist. Please print clearly. ... • Feel free to ask your therapist any questions before, during, or after the session. Your therapist is
Client Intake Form For Massage Therapy ... Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and have answered all questions honestly.
Finding Balance Massage Therapy Client Information ... Feel free to use the back of this form if necessary. Do you have any contagious diseases? ... Client Intake Form Author: Diane Created Date:
Massage Client Intake Form . The Benefits of Massage Massage is an excellent preventive treatment essential for the maintenance of health ... happy and harmonious life free of illness. People have been enjoying the benefits of massage for thousands of years.
Massage Information ... known medical conditions and answered all questions on the Client Intake Form honestly. I agree to keep the ... Feel free to ask your therapist any questions before, during or after the session. Your therapist is a highly
The relationship between the client and massage therapist is a confidential one ... massage therapist also has the right to be free from any unwanted, harmful, offensive, ... CLIENT INTAKE FORM Author:
Leslie Whitten, LMT TX#MT110213 ABMP & NCBTMB Certified Client Intake Form Full Name Birth Date Gender Email Address Cell Phone Number Work Phone Number
Client Consultation Form ... • Feel free to ask any questions before, during, or after the session. I have received the policy statements, and have read and agreed to the policies therein. ... Recuperate Massage Intake Form 4 Author:
Pregnancy Massage Client Intake Form 2 Please check ( √ ) current problems, mark with (+) if you had in the past : ___ anemia
Short Form Intake Location, Structure, ... massage/body-work practitioners are not qualified to perform spinal or skeletal adjustments, ... affiliates based on any act or omission of High Performance Massage, its agents, or employees. Client Signature: ...
Massage and Stretch History . Have you ever received a professional massage? ___Yes ___No If yes, frequency: _____ Last Massage _____ What ... Massage Therapy Client Intake Form Created Date:
Client Intake Form – Reflexology Personal Information: Name _____ Primary Phone _____ Address _____ City/State/Zip_____ Email_____ Date of ...
Client Intake Form Occupation/Employer ... I do not handle insurance forms, but will be glad to give you a receipt for you to submit to your insurance company for possible reimbursement. ... The client may stop the massage at any time and is free to leave. The client may refuse any massage methods.
Massage Therapy Intake Form » **It is the policy of Healthquest that payment be made at the time of service. Receipts are provided for the patient to arrange reimbursement from your extended insurance policy if applicable.
Please list any special dietary/nutritional considerations: (ie: gluten-free diet, ... Massage therapy for a child is not intended to replace other forms of healthcare. ... Pediatric Client Intake Form
Elbe Body - Massage Therapy Linda E. Koop, LMT www.elbebody.com 811 W. St. Johns Ave., Suite 2105 Austin, Texas 78752 512.944.0456 CLIENT INTAKE FORM
Massage Essentials Rachel M. Strenge-Malecha 406 Ivanhoe Ave Northfield, MN 55057 (507)664-9303 Client Intake Form Ear Candling Name: _____
Body in Balance Massage Therapy & Hydrotherapy 8837 Guide Meridian Rd. Lynden, Washington 98264 Office: (360) 354-0359 Fax: (360) 354-4886 New Patient/Client Intake Form
Confidential Client Information And Health History ... massage therapy is not a substitute for medical attention or examination. I take responsibility for alerting ... Microsoft Word - massage_intake_form.doc Author: Dr H Created Date:
Elements Therapeutic Massage Intake Form 5/15/2012 Form 4.12 Ther Initials: _____ I am ... during the massage. A statement that if the client is uncomfortable for any reason, the client may ask the therapist to cease the massage, and the therapist will do so.
Client Agreement: PLEASE read the following statement and sign and date on the line to indicate that you have read the statement and understand it. Massage is a service intended for enhancing your health and quality of life. ... MASSAGE Intake form.doc
Massage Client Waiver Form Please take a moment to read the following information: I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and
Client Intake Form for Reiki Treatment ... I also understand that this is not a massage therapy session and that I will remain fully clothed (except for shoes and/or socks) during the entire session.
RECORD KEEPING FORMS FOR MASSAGE THERAPISTS AND BODYWORKERS. INTRODUCTION ... INTAKE FORMS Short Form Single-page form for relaxation massage, spa treatments, or wellness therapies of any kind. ... Free Form Client Chart Notes
Title: Prenatal Massage Client Intake Form Author: Lauren Wipperman Subject: Form Created Date: 9/22/2008 9:42:53 PM
Because massage/energy therapy is contraindicated (should not be done) under certain medical conditions, I affirm that I have stated all my known medical conditions, ... Microsoft Word - Client Intake Website.doc Author: Owner Created Date:
... I hereby authorize Sandy McC I hereby authorize Sandy McClelland to administer B lelland to administer Bodywork/Massage odywork/Massage ... Client Intake Form Keywords: Client Intake Form Created Date:
Massage Client Information and Consultation Form . On this diagram please circle the areas of the body that you feel need the most attention in the massage session, and place an “X” over the areas that you wish to have avoided.
CONFIDENTIAL CLIENT INFORMATION MASSAGE INTAKE FORM Welcome! We want to make your appointment as pleasant and comfortable as possible. If at any time you have questions regarding your therapy session, please, let us know.
Manicure & Pedicure Confidential Client Intake Form Full Name: _____ Address ... and I understand that Cosmic Touch Massage & Nails reserves the right to deny service to any client due to disease or potential contamination of service area.
Waves CLIENT INTAKE FORM A Healing Spa (CONFIDENTIAL-FOR PRACTITIONER’S USE ONLY) ... Waves Spa offers a variety of treatments including Massage, Brennan Healing, ... including allopathic medicine. Please feel free to discuss your treatments here at Waves Spa with your doctor.
MASSAGE THERAPY INTAKE FORM HEALTH HISTORY The information below will assist us in treating you safely. Feel free to ask any questions about the information being requested. ... The client is responsible for payment upon receiving the services.