Digital Health Intake & Waiver

Client Intake Questionnaire

Please complete this form to ensure your massage session is safe and effective.

Full Name:

Email Address:

Emergency Contact (Name & Phone):

Preferred Massage Pressure:

Health Conditions & Focus Areas:

Tech-Neck & Desk Strain Lower Back & Sciatica High Blood Pressure Rotator Cuff / Shoulder Injury Frequent Tension Headaches Pregnancy

Additional Medical Details or Recent Surgeries:

Skin Allergies or Essential Oil Sensitivities:

Massage Therapy Liability Waiver & Consent

I understand that massage therapy is intended for muscular relaxation and pain relief and does not replace medical diagnosis. I agree to notify therapist Alexa Martinez NCLMBT #10918 of any health changes.

Touchscreen E-Signature:

Sign using your finger or mouse cursor in the box above.

Digital Signature Full Printed Name:

Intake Form & Waiver Submitted!

Client Intake Questionnaire

Massage Therapy Liability Waiver & Consent