Soul Rise Wellness

If it's your first time meeting with me, please take five minutes to fill out this client intake form before the day of your session so I can better serve you. Mahalo!

Intake Form

Medical Information

Are you taking any medications?
Are you currently pregnant?
Do you suffer from chronic pain?
Have you had any orthopedic injuries?
Please indiate any of the following that apply to you:

Massage Information

Have you had a professional massage before?
What type of massage are you seeking?
What pressure do you prefer?
Do you have any allergies or sensitivities?
Are there any areas (feet, face, abdomen, etc) you do not want massaged?

I understand that massage is not a replacement for medical care and that no medical diagnosis will be made. Because massage and bodywork therapy may be contraindicated due to certain medical conditions, I affirm that I have informed the therapist of all known medical conditions and will keep the therapist updated as to any changes in my medical condition going forward. If I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or manipulations, draping or environment may be adjusted to my level of comfort.

INAPPROPRIATE BEHAVIOR POLICY - I understand that massage therapy is for relaxation and therapeutic purposes only. There is absolutely no sexual component to massage whatsoever. Any insinuation, joke, gesture, conversation, or request otherwise will result in immediate termination of my session and a refusal of any and all services in the future. I understand that I will be charged the full service fee regardless of the length of my session. I understand that depending on the inappropriate behavior exhibited a report may be filed with the local authorities if necessary. I will treat the therapist with respect and dignity and in return I will be treated the same.

By printing your name below, you agree to the following:

I have completed this form to the best of my ability and knowledge and agree to inform my therapist if any of the above information changes at any time.