Weekend Lake House
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Please complete this form so we can plan for your specific massage requests.

Name: *

E-Mail Address: *

Date and time you would like your Massage Session? *
:

Have you had a professional massage before?
 
 

If yes, approximately how many times?

Do you prefer a Male or Female Massage Therapist? *
 
 

Do you have any medical conditions, are you pregnant, or have any physical problems with your body (injuries or otherwise) that the therapist should be aware of? *
 
 

(If "yes" the Therapist will ask you to explain during the pre-massage interview.)

Are you taking any prescription medications for problems such as Diabetes, Heart problems, high blood pressure, epilepsy or seizures, etc.? *
 
 

Have you been in an accident or broken any bones in the last 2 years? *
 
 

Your massage will be a "full body massage" all areas include Gluteus Maximus - (butt), Pecks, Lower Stomach, etc. Is there any of these areas you do not want to included? *
 
 

(If "Yes" the Therapist will ask you during the pre-massage interview which areas to avoid.)

Do you want you face massaged? *
 
 

Are there any areas of your body that you would like the therapist to focus more time on during the massage - i.e. face, scalp, neck, shoulders, upper back, lower back, arms, hands, gluteus, pecks, legs, feet, etc.? *
 
 

( If "yes" the Therapist will ask you about those areas during the pre-massage interview.)

Optionally, is it OK if the draping is removed for the Gluteus area? *
 
 

What massage pressure do you prefer? *

What style or type of massage would you like to have? *
 
 
 
 
 
 

 

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