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MHH Massage New Client Intake

The MHH Massage New Client Intake form is required to be complete/submitted. The form is designed to collect your personalized information and health history so that we may better serve and protect you. Each individual is responsible for completing and submitting this form prior to receiving your massage session. Failure to do so will result in appointment cancellation without a refund. We appreciate your timely submission!

MHH MASSAGE NEW CLIENT INTAKE

Complete/submit the required 'MHH New Client Intake' form below prior to your massage session.

Birthday (for age verification)
Month
Day
Year
Emergency Contact Relationship To You?
What is your experience with having a massage?
Are you in need of treatment to a specific focused area(s)?
If YES, select the area(s) to focus on? (or select none from menu)
Are there any areas of the body you wish to avoid having massaged?
If YES, please select the area(s) (or select none from menu)
Is your pain (any) due to a recent accident or sports injury?
Has a doctor or therapist recommended massage to manage pain?
Has a physician ever advised you against massage?
Are you currently undergoing chemotherapy for Cancer (any kind)?
Do you currently have a pacemaker in you?
How Did You Hear About MHH Massage?
We appreciate the love! After your massage if you had a great experience are you willing to write us a review?

Leave us a 5-Star review with details of your positive experience to get 30 min towards next massage (pending time availability)*

Massage Waiver of Liability (women only)*

Are you currently pregnant or think you may be pregnant (women only)?

Massage Waiver of Liability (all individuals)*

Informed Consent Agreement

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