New Client Intake Form: Start Your FlowState Massage Journey

Please complete all fields as accurately as possible. Your information is confidential and helps us provide safe and effective treatment.

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Personal Information

Medical Information

Are you taking any medications?

Are you currently pregnant?

Do you suffer from chronic pain?

Have you had any orthopedic injuries?

Please indicate any of the following that apply to you

Your Health History and Medical 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?

Consent

By signing 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.