Ojas Massage Therapy Health Screen
We want to provide you with the best massage possible.
Please take a moment to update us on your health.
Date of Birth
Safety First! Please list all health conditions here because even though it might seem unrelated to massage, it could be! (i.e. uncontrolled high blood pressure, blood clots, recent injuries)
Please list any specific areas you would like your massage therapist to focus on.
Why does it hurt? Was there anything specific that contributed to your pain in the areas listed above? (i.e, injury, chronic overuse, etc.)
Extras don't cost extra at Ojas! Which complimentary service upgrades would you like included in your massage? (You may select multiple options.)
Aromatherapy (to release anxiety)
Warm Stones (to deeply relax muscles)
Warm Towels/Heat Wraps (to relieve pain & tension)
Are you on any medications?
If so, what medications are you on?
Any surgeries in the last five years?
Do you have any allergies to oils, nuts or fragrances?
If so, what are you allergic to?
Are you pregnant?
Have you had a massage before?
If so, when was your last massage?
Where did that massage take place?
24-Hour Cancellation Policy
Because of our high demand and premium service, we request the courtesy of a 24 hour cancellation notice for all acupuncture, massage, and skin care appointments. Cancellations of less than 24 hours and no shows will be charged 100% of the service fee. Gift cards will be reduced by the value of the service, and clients with a WellPass® will be charged one unit of that program.
I have read the policies and agree to adhere
Terms & Conditions
I understand that I will be receiving massage therapy for the purpose of stress reduction, relief from muscle tension or spasm, or for increasing circulation and energy flow. I understand that the massage therapist does not diagnose illness, and, as such, the massage therapist does not prescribe medical treatment or pharmaceuticals, nor does he or she perform spinal manipulations. I am aware that this massage is not a substitute for medical examination or diagnosis, and that it is recommended that I see a physician for any ailment I might have. I understand and agree that I am receiving massage therapy entirely at my own risk. In the event that I become injured either directly or indirectly as a result, in whole or in part, of the aforesaid massage therapy I hereby and hold harmless Ojas Wellness Center, the therapist, his or her principals, and agents from all claims and liability whatsoever.
I have read and understand the above information and policies and have provided all requested information to the best of my knowledge. I understand that massage therapy does not constitute medical treatment. I take full responsibility for alerting the massage therapist of any conditions that arise which may affect the massage session. For non-English speaking clients, a translator must be present for the duration of the service
I have read and voluntarily agree to the terms and conditions above.
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