Client Record: Massage

Please complete this form. This information is critical to your session(s) as it may affect the focus and outcome of it. All information disclosed will be kept for session purposes only and in strict confidentiality.

Massage History/Information

(Ex: face, scalp, feet, abdomen, buttocks)

**If you experience any pain during the session(s), please immediately inform the therapist, so that the work can be adjusted to your level of comfort.

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