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New clients

New client form

Please fill this in before your first session. It takes about five minutes and helps me keep your massage comfortable and safe. It is private: only I read it. Prefer paper? You can print this page and bring it to your appointment, or I can help you fill it in at the studio.

Thank you for your interest in a massage with Your Soothing Moment. What you write here is confidential. It is read only by your therapist, to keep your session comfortable and safe. Skip anything you would rather tell me in person.

About you

Health information

Are you taking any medications?
Any allergies? (oils, lotions, nuts, fruits, skin, etc.)
Are you pregnant?
Are you currently under medical supervision or other medical interventions?
Any areas of broken skin? (rash, wounds)
History of joint replacement surgery?
Recent injuries or medical procedures in the past 2 years?
Do you have any of the following? Check all that apply.

About your massage

Have you had a professional massage before?
Reason for seeking massage
How much pressure do you prefer?

Acknowledgement

Massage here is for relaxation and comfort and is not a substitute for medical care. By typing my name below I confirm that I have completed this form to the best of my knowledge, that I understand the benefits and risks of massage, and that I will tell my therapist about any health or medical changes.

Your answers are saved privately on this site and are never sold or shared for marketing. See the privacy policy. Please do not send photos or ID through this form.