Massage Intake Form
CASE HISTORY:
This Intake form must be completed and signed before receiving massage treatment.
I agree to the terms and conditions provided by Synergy Massage & Wellness. By providing my email and phone number, I consent to receive email and SMS communications (reminders, promotional etc.). Message and data rates may apply. Unsubscribe any time by replying STOP or clicking the unsubscribe link.
GENERAL & MEDICAL INFORMATION:
Payment Info
I understand that the massage provided is for relaxation and relief of muscular tension. If I feel any pain or discomfort, I will inform the therapist so they can adjust the pressure or techniques as needed. I acknowledge that massage is not a substitute for medical examination, diagnosis, or treatment, and therapists are not qualified to perform spinal adjustments, diagnose, prescribe, or treat illnesses. I have disclosed all known medical conditions and answered intake questions honestly. I will update the therapist on any changes in my health, and I understand the therapist may refuse service if massage is contraindicated.
Please note that massages canceled with less than 24 hours' notice are subject to a $50 cancellation fee.