Client form

Client form

DD slash MM slash YYYY
Have you ever had a massage before
Do you have any of the following medical conditions:


This place of business will not be held liable for any injury or condition that arises from application of massage. This form is intended as an assessment tool only and serves as a guide for the application of massage not for medical treatment or medical assessment. Draping will be used during this session. Only the body area being worked on will be uncovered. Clients under the age of 18 must have a parent or legal guardian present to provide a signature for authorisation for the therapeutic massage session and must be with the same gender massage therapist.


By signing this intake form, you agree that if you need to cancel or reschedule an appointment, you will have until the close of business the day before your appointment to cancel to avoid being charged a fee. Any cancellations, not showing up to your appointment or changing your appointment the same day will result in a full charge of the session.


I have stated all conditions that I am aware of and this information I provided is true and accurate to the best of my knowledge. I agree to information my massage therapy immediately of any change in the conditions stated above. I acknowledge this information is confidential and intended for review by manage therapist, that a medical referral may be required for me; and that Zensations Massage is not liable for the management of any condition. If uncomfortable for any reason, the client may end the session. I also understand that any illicit or sexually suggestive remarks or advance made by myself will result in immediate termination of this season, and I will be liable for full payment of the appointment.
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Copyright 2024 | Zensations Massage Hervey Bay