Massage Therapy Center of Sylvania Intake Form

Welcome to Massage Therapy Center of Sylvania, please fill out the form below before your first visit with us.  

Registration

To register, please take the time to fill out the information below before your first appointment. See you soon!

Reason for Massage
Check if You Are Experiencing or Have Any of the Following
Check if You Are Experiencing or Have Any of the Following

I hereby give consent to Massage Therapy Center of Sylvania and any of their

licensed massage therapists to perform therapeutic massage therapy with the

understanding that the results vary from each person and no specific results can

be guaranteed. I understand that a massage therapist is not qualified to

diagnose, treat or prescribe for any illness or disease.

I hereby state that the above information is completed to the best of my

knowledge and it is my responsibility to provide updated medial/physical

conditions. I waive and release Massage Therapy Center of Sylvania and my

licensed massage therapist from any/all liability or complications past, present

and future relating to massage therapy and bodywork. I also understand that

any inappropriate comments and/or behavior will result in termination of the

massage and full payment will be required.

Please be advised that all information is confidential and will not be released

without written consent from you. If you are unable to keep an appointment,

please give a 24 hour notice or as early as possible. Thank you for your time and choosing Massage Therapy Center of Sylvania!

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Have You Had A Fever Or Been I'll In The Past 5 Days!?
Have You Ever Had a Professioal Massag Before

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