Your name:
Your e-mail:
Date of Birth
Length
Weight
Telephone number
Have you ever had a massage therapy session before? YesNo
What is this massage for? RelaxationSore or tight musclesInjury rehabInjury preventionMobilityPerformance before workoutRecovery after workoutOther
What part(s) of the body are you having issues with?
Do you have an injury for which you are seeing a medical professional? If yes, what injury?
What is your expectation of a massage session in general?
What type of massage have suited you best in the past? PainfulSoftSpecialty mobilizationsAll types as long as it helps
Do you have any allergies?
Are you taking any medication that counteracts or might influence the massages?
Have you had any bad experiences with massage therapy? If yes, please explain.
I understand that the massage given to me by Evolution Fitness is for the purpose of (stress reduction, pain reduction, relief from muscle tension, increasing circulation, or specific reasons stated here). I understand that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy. I understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have. I have stated all my known physical conditions and medications, and I will keep the massage therapist updated on any changes."
