Before Your Session

Health Intake Form

Please complete this form before your first appointment. Your health information helps us provide the safest and most effective session possible. All information is strictly confidential.

Client Information

Full Name *

Date of Birth

Phone

Email *

Emergency Contact (Name & Phone)

Primary Physician

Health History

Please check any conditions that apply to you:

Current Medications

Recent Surgeries or Injuries

Are you currently pregnant?

Massage Preferences

Have you received massage before?

Preferred Pressure

Areas to Focus On

Areas to Avoid

Primary Goal for Today's Session

Consent & Agreement

I understand that the massage therapy provided is not a substitute for medical treatment. I have disclosed all known health conditions and medications. I consent to receive massage therapy from Summer Luv and understand that I may stop the session at any time. I acknowledge the cancellation policy.

I agree to the above consent and confirm the information provided is accurate. *