MASSOLOGY WELLNESS
CLIENT DIGITAL HEALTH FORM

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Describe briefly your goals/reasons for receiving massage therapy:

Do you have any areas you wish your massage therapist to focus on today?

List any areas you DO NOT like or want worked and want your therapist to avoid:

Please list any recent surgeries or injuries:

Please select any applicable health conditions:AllergiesArthritisAsthmaCancerCirculatory ProblemsDiabetesEpilepsy/SeizuresFlu/ColdHeadachesHeart ConditionsHigh Blood PressurePrevious MVA/traumaOsteoporosisScoliosisSkin DisordersSinus ProblemsVaricose VeinsMental Health Conditions

Please read the Terms & Conditions as well as the Private Policy and state your agreement. *

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MASSOLOGY WELLNESS CLIENT DIGITAL HEALTH FORM

MASSOLOGY WELLNESS
CLIENT DIGITAL HEALTH FORM