top of page

Client Intake & Release Form

Please fill out the following form
in order to participate in massage services.

How would you rate your general health? Required
Do you have a sedentary job? Required
How often do you engage in physical activity outside of work? Required
Have you had a professional massage before? Required
Head and Neck Required
Nervous System Required
Respiratory Required
Respiratory Required
Cardivascular Required
Other Conditions Required
Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

Thanks for submitting!

Copyright 2015-2021Ā© Ceremonial Health LLC / Llame al 617-755-4299/ Bozeman MT 59715

bottom of page