Massage Consent Form

Massage Consent Form

PATIENT INFORMATION

GENERAL

CARDIOVASCULAR

Indicate conditions currently or recently experienced

RESPIRATORY

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DIGESTIVE

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HEART & NECK

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MUSCLE / JOINT / BONE

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INFECTIOUS CONDITIONS (PRESENT)

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WOMEN

Indicate conditions currently or recently experienced

OTHER CONDITIONS

Indicate conditions currently or recently experienced

SKIN CONDITIONS (NON-CONTAGIOUS)

Indicate conditions currently or recently experienced

WAIVER

Sending