(954) 787 2023

Informed Consent

for Massage Therapists

INFORMED CONSENT FOR MASSAGE THERAPISTS

Failure to fill out the following consent authorizes the masseuses to reject the scheduled appointment. The consent must be sent 24 hours before the scheduled appointment. Note: if you haven't received the reservation confirmation email, please check the SPAM tray.
Your Name(Required)
Direction to take Therapy *(Required)

About You

Please make sure to add the important information below, about your medication, doctor, age, allergies, and others.
Please enter a number from 0 to 100.
Date of Birth(Required)

Have you had a professional massage before?(Required)
Have you ever had surgery?(Required)
Do you have any spinal problems?(Required)
Do you wear contact lenses?(Required)
Are you pregnant or do you have an IUD?(Required)
Do you have high blood pressure?(Required)
Do you suffer from chronic low back pain?(Required)
Do you have varicose veins?(Required)
Do you have frequent headaches?(Required)
Always tired?(Required)
Do you have heart problems?(Required)
Do you have blood clotting problems?(Required)
Do you have any pain radiating down your legs or arms?(Required)
Arthritis?(Required)
Do you have diarrhea or chronic constipation? *(Required)

Consent(Required)
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BOOST iMMUNITY & dETOXIFY

Our specialized massages help strengthen your immune system, reducing the risk of post-surgical infections and complications.

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(954) 787 2023

info@equilibriumlyphatic.com

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