The following information will be used to help plan safe and effective massage therapy sessions. Please answer the questions to the best of your knowledge.

Health History ( Please check ALL that apply)

Please indicate with the associated letters the areas in which you are feeling discomfort:

The following sometimes occurs during massage. They are normal responses to relaxation. Trust your body to express what it needs to:

-needs to move or change position

-sighing, yawning, change in breathing

-stomach gurgling

-emotional feelings and/or expression

-movement of intestinal gas

-energy shifts

-falling asleep



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