Please answer the following questions so that we have a better understanding of your general health and lifestyle. This will aid your Skin Care Professional in a more accurate analysis and/or the possible contributing factors to progress and improvement of your skin. Thank You!

General and Medical Information


*Please note that we cannot perform prenatal massages unless you've completed your first trimester

Indicate Areas of Pain/Tension

On a scale from 1-10, 10=highest, rate your levels of


Please check all that apply

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 pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.

I understand that the services offered today are not a substitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.

I affirm that I have notified my therapist of all known medical conditions and injuries.

I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist's part should I forget to do so.

I understand that the massage is entirely therapeutic and non-sexual in nature.

By signing this release, I hereby waive and release my therapist from any and all liability, past, resent, and future relating to massage therapy and bodywork.

I understand that should I cancel an appointment less than 24 hours before the scheduled time or "now show" an appointment, I am subject to a $50 fee. If the appointment is booked under a gift certificate, it will be voided in lieu of the fee.

Information and Suggestions

  • Prior to your massage, please remove contact lenses and all jewelry. Pull long hair back with a clip or band.
  • In general, massage is given while you are unclothed. However, you may choose to wear undergarments or a swimsuit. You will be covered with a top sheet throughout your session. This is your massage and you should feel as comfortable as possible.
  • Feel free to ask you therapist any questions before, during, or after the session. Your therapist is a highly trained professional and will be happy to make you feel informed and comfortable.