Intake Form

Name

First Name

Last Name

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Allergies/Sensitivities/Injuries

Medications

A small handful of medications can be contraindicated for massage. Things like blood thinners can lead to bruising with deep tissue. Time-release medications like injectable PrEP or birth control can be contraindicated for massage directly on the injection site.

Areas of Focus

What's bringing you in for massage?

Areas to Avoid

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