Are you claustrophobic? YesNo
Do you have Diabetes? YesNo
Have you had a professional massage before? YesNo

Do you have any difficulty lying on your front, back, or side? YesNo

Do you have any allergies to oils, lotions, or ointments? YesNo

Do you have sensitive skin? YesNo
Do you wear contact lenses, have dentures or us a hearing aid? YesNo
Do you sit for long hours at a workstation, computer, or driving? YesNo

Do you perform any repetitive movement in your work, sports, or hobby? YesNo

Do you experience stress in your work, family, or other aspect of your life? YesNo

Is there an area of the body where you are experiencing tension,stiffness or discomfort? YesNo

Are you currently under medical supervision?YesNo

Do you see a chiropractor? YesNo

Are you currently taking any medication? YesNo

Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire session. Informed written consent must be provided by parent or legal guardian for any client under the age of 17.