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Client Intake Form

Services requested*
Last Menstrual Cycle is for potential Fertility Massage clients. Estimated Due Date or Delivery Date is for Prenatal/Postpartum/Scar Massage clients. And Injury Date would be for Therapeutic Massage clients.
Have you had a professional massage before*
It is important that I am aware of medications, allergies and/or surgeries to make sure that it is safe for you to receive massage.
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Please complete prior to your scheduled massage session.