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Client Intake & Release Form

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

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

Thanks for submitting!

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