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Client Intake Form

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Would you like to receive special discounts and promotions via email?

Have you received a professional massage in the past?(Required)
Was your experience pleasant?(Required)
What is your massage pressure preference?(Required)

Do you have any allergies and/or skin sensitivies?(Required)
Are you taking any medications, non-prescription drugs or supplements? Please check all that apply:(Required)
Please check all current or past conditions that apply:(Required)
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Client Agreement:

I understand that massage therapy is provided for the basic purpose of relaxation and relief of muscle tension. Massage therapy is not a substitute for medical diagnosis and/or treatment. If I experience any pain or discomfort during the session, I will alert the practitioner so modifications can be made. Because massage therapy is contraindicated under certain medical conditions, I agree to fully disclose all of my known medical conditions and medications. I agree to keep my medical profile updated and understand that there shall be no liability on the practitioner’s part should I fail to do so. I agree to consult with my physician if I have any concerns with receiving massage therapy prior to attending a massage therapy appointment. I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will still be responsible for full payment of the session.

My signature also indicates my consent to the following: Failure to cancel appointments at least 24 hours in advance or failure to show up for my appointment will result in a charge of 50% of the scheduled appointment fee which will be processed on the credit card retained on file to reserve appointments. If a credit card is not available to charge, I understand that a bill will be sent to my home and agree to pay such bill.

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LIVING LIGHT MASSAGE

info@livinglightmassage.com
231.995.9697
214 N. Division St.
Traverse City, MI 49684

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HOURS

Mon, Tues, Thurs 9:00-5:00

Wed 9:00-3:30

Fri 9:00-3:30

Saturday CLOSED

Sunday   9:30-3:30

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