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Massage Intake Form

First name*

Last name*

Email*

Phone*

Emergency Contact:

How did you hear about me?

Please list any medical conditions, past injuries and surgeries.

Do you have any allergies or sensitivities? (ie. fragrances, nut oils, CBD)

Any places you want me to avoid? (ie. feet, scalp, face)

What pressure do you like?

Special preferences (ie. likes/don't likes, no music, minimal talking)

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