Health Waiver
Please take a minute to fill in the following info before your session/class/event
First Name
Last Name
Phone Number
Email
Birthdate
Are there any injuries/health conditions that may impact your massage/treatment/class?
Yes
No
If so - where are your injuries/health conditions?
Do you have any allergies? (Including to essential oils)
Yes
No
If so - what are your allergies?
MASSAGE ONLY - please name areas of pain or tension that you are having today (i.e. upper back, low back, quads., etc)
I agree to the terms & conditions provided on our website
Date
Your Signature
*
Clear
Submit