Skip to content
Faithfully Therapeutic Massage Consent Form
Do you prefer no talking in your service?
What kind of pressure do you prefer?
Last professional massage?
List the medications you currently take:
Are you pregnant?
How far long?
Have you had any injuries or surgeries that may influence today's treatment?
If YES, how?
Choose any of the following health conditions that you CURRENTLY have or have had in the past. Please answer honestly, as massage may cause harm if the below conditions apply.
Past varicose veins
Congestive heart failure
High/Low blood pressure
Shortness of breath or asthma
Headaches / Migraines
Stroke, Heart attack
Consent for Treatment
, understand that the massage I am about to receive is solely for the purpose of relaxation....
I agree to and understand the above mentioned terms and conditions.
By submitting this form, I give my consent to receive care.
This iframe contains the logic required to handle AJAX powered Gravity Forms.