Health information What results are you looking for from this massage?
Have you ever had a massage before?
Are you on any medication?
If yes, please list:
Are you pregnant?
If yes, your due date
Have you had surgery in the last 5 years?
If yes, please list the procedures and dates:
Any injuries, trauma, or accidents in the last 5 years?
If yes, please describe what happened and the dates:
I have difficulty lying on my:
Summarize your exercise routine:
Do you see other health practitioners?
Please check all that apply:
Please list anything noted above (allergies, arthritis, etc.) or any other relevant information:
