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Elite Personal Training and Fitness Solutions Massage Health History Questionnaire

Present Medical History (please check off if you have had any of the prolems listed below)
Review of Systems
Are you currently pregnant?
Do you suffer from chronic pain?
Have you had any injuries?
Have you had a professional massage before?
What type of massage are you seeking?
What pressure do you prefer? (In general, adjustments will be made as needed)

By signing below, you agree to the following. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have completed this form to the best of my ability and knowledge and agree to inform my therapist of any relevant health information or if any of the above information changes at any time.

I understand that Elite Personal Training and Fitness Solutions and Amy Goldman, LMT operate on a scheduled appointment basis for massage sessions and that cancelling an appointment requires at least 24-hour notice. If I cancel a session with LESS than 24-hour notice I will be charged and agree to pay for the full-service charge.

 

I have read and completely understand and accept these terms:

Thanks for submitting!

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