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Mobile Massage is available upon request ONLY.

Fill out the Mobile Massage Intake Form form below and Joyful Bodies Massage will contact you soon to schedule an appointment.

Multi-line address
Birthday
Month
Day
Year
Are you currently under a physicians care for an acute or chronic illness?
Yes
No
Are you taking any prescribed medication(s) or dietary supplements?
Yes
No
When would you like your mobile massage?
Month
Day
Year
Time
HoursMinutes

I have stated all conditions that I am aware of and this information is true & accurate to the best of my knowledge.I will inform my massage therapist if anything changes in my status. I understand that massage/bodywork I receive is for the purpose of stress reduction and the relief from muscular tension, spasm, or pain and to increase circulation. If I experience any pain or discomfort, I will immediately inform my massage therapist so that the pressure and/or methods can be adjusted to my comfort level. I understand that my massage therapist does not diagnose illness or disease, nor perform any spinal manipulations. and does not prescribe any medications/treatments. I acknowledge that massage is not a substitute for a medical examination or diagnosis and that I should see my health care provider for those services. If I am unable to attend my scheduled appointment, I will respect and abide by the set cancellation policies. Sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature will constitute as sexual harassment and will not be tolerated. I understand that I am receiving massage therapy at my own risks. In the event that I become injuries either directly or indirectly as a result, in whole or in part, of the aforesaid massage therapy I hereby hold harmless and indemnify the therapist, their principals, and agents from all claims and liability whatsoever.

Date Of Signature
Month
Day
Year
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