407 443-1550 Multi-Modality Approach To Pain Relief MM28729
407 443-1550Multi-Modality ApproachTo Pain Relief MM28729
Intake Form












We consult with all our patients first to make sure they are healthy to receive massage. 

Please complete the above health intake form and submit to us before your appointment.


This allows you to point out specific areas of discomfort while allowing us that extra time to ensure your expectations are met.



Why is the health history important?


The health history form is important because it gives an overview of a patient's health so the therapist can proactively determine the correct treatment, or even if the patient should receive massage. Please remember that what you say to your massage therapist is confidential.  Your massage therapist will not discuss your medical issues with anyone unless you have signed a consent form giving your therapist permission to do so. 


Massage is not recommended for everyone, the following are some of the conditions contraindicated for massage:

  • Infectious skin disease, rash, open wounds
  • Immediately after surgery, chemotherapy, radiation unless doctor recommended
  • Those with blood clots
  • Tumor, inflamed skin, unhealed wounds
  • High fever, pitted edema
  • Acute inflammation, kidney disease
  • Women in their 1st trimester
  • Heart disease - get ok from your doctor

Also, no food, RX or alcohol 2 hours before your treatment.