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Client Intake Form

General Information

Please fill out this form to the best of your ability. 

Have you received professional massage care in the past?

Medical Information

Please mark all that currently apply.

Nervous System
Other
Digestive
Muscular-Skeletal
Circulatory/Respiratory
Reproductive

Massage Informed Consent and Agreement

 

It is my choice to receive Thai massage, and I understand that the session is intended for relaxation, muscle tension release, increased range of motion, improved circulation, reduced stress, increased energy flow and balance, and a positive opening experience. I understand that Thai massage is not a substitute for medical treatment, examination, or medications, and that it is recommended to concurrently work with my primary caregiver for any condition that I may have. I have informed the Thai massage practitioner of all my known physical and medical conditions and medications, and I will keep her updated to any changes in my health status. I understand that all information regarding my health history, the records of my sessions, and other personal information related to the session will remain in complete confidence. If this information is requested, I will release it under written consent. I will follow the 24-hour cancellation policy via phone, or I will need to pay the full amount for the massage (unless it is an emergency situation).  Thank you.

Contact Me

Lucy Kay

3825 Iris Ave Suite 250b 

Boulder, CO, 80301

lusea90@gmail.com

608-886-7938

Thanks for reaching out!

LKBODYWORK. 2023.

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