NEW CLIENT INTAKE FORM

Welcome to Life Yoga Massage! Our therapists listen to your needs and employ the proper techniques to deliver a truly therapeutic experience. By providing us with the following valuable information, we will be able to live up to our high standards and you'll receive a skilled and rejuvenating therapeutic massage that will get your body feeling great. Thank you for your time and we look forward to meeting you!

How would you like to receive appointment reminders?
The easiest and most efficient way to book and pay for sessions is through the Mindbody app. Would you like to take advantage of this free tool?
Medical Information
Are you currently pregnant?
Do you suffer from chronic pain?
Have you had any orthopedic injuries?
Please indicate any of the following that apply to you.
massage information
Have you had a professional massage before?
What type of massage are you seeking?
What pressure do you prefer?
Do you have any allergies or sensitivities?
Are there any areas (feet, face, abdomen, etc.) you do not want massaged?
Do you currently have any areas of discomfort?

By signing below, you agree to the following: I give my permission to receive massage therapy. I understand that therapeutic massage is not a substitute for traditional medical treatment or medications. I understand that the massage therapist does not diagnose illnesses or injuries, or prescribe medications. I have clearance from my physician to receive massage therapy. I understand that the risks associated with massage therapy include, but are not limited to: superficial bruising, short-term muscle soreness, and exacerbation of undiscovered injury. I therefore release Life Yoga and their massage therapists from all liability concerning these injuries that may occur during the massage session. I understand the importance of informing my massage therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition. I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so he/she may adjust accordingly. I understand that I or the massage therapist may terminate the session at any time. I have been given a chance to ask questions about the massage therapy session and my questions have been answered. If you understand and agree to these terms, please sign below.

Your Signature

You will be redirected to register online with Life Yoga Studio