Therapeutic INTAKE FORM
Please complete the information below prior to your appointment.
Health History & Terms of Service
*If you have a specific medical condition or specific symptoms, massage therapy may be contraindicated.*
I understand that the massage/bodywork I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during this or future sessions, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage/bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said while under the care of Rootbloom Bodywork and its practitioners should be construed as such. If pregnant, I give permission for Stephanie Parsons, LMT or associated contractors to provide licensed massage therapy while I am in early/active labor.
Because massage therapy should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered questions honestly. I agree to keep Rootbloom Bodywork, Stephanie Parsons, LMT, and its contractors updated to any changes in my medical profile and understand that there shall be no liability on the practitioners part should I fail to do so.