New Patient Intake Form:

After you have scheduled your first massage session, please complete the New Patient Intake Form below and click Submit. This is required for all new patinets to fill out before your massage appointment.

New Patient Form.

Please fill out Before Massage Session!

First name and Last name

Phone

You agree to be contacted about your appointments by Phone/Text.

I agree to be contacted by Phone/ Text

Are you an active member of the military or a veteran with VA ID?

Yes

Are you a resident of the columbia, sc area or visiting the area?

Resident

Visitor

Do you have any of the following Health Conditions? Cancer, HIV, Skin Disorder Such as psoriasis, Diabetes, High Blood Pressure, Arrhythmia, Defibrillator installed, Heart Failure, Epilepsy, Neuropathy or Paralysis, contagious disease or any allergy?

Yes

If yes please explain which condition(s) / Allergies you have.

In a brief description, Tell me what areas of the body are troubling you.

By Checking this Box you agree that all the information contained within this form is correct and truthful. You understand that there could be risks to your health if information is not truthful or complete and that you waive liability against the therapist in that event. You agree that the Licensed therapist reserves the right to refuse treatment to anyone with a conflicting medical issue and or behavior that could endanger the patient, therapist or their equipment.

Providing Professional Massage & Compressive Therapy

New Patient Intake Form:

After you have scheduled your first massage session, please complete the New Patient Intake Form below and click Submit. This is required for all new patinets to fill out before your massage appointment.

New Patient Form.

Please fill out Before Massage Session!