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Client Intake & Release Form

Please fill out the following form
in order to participate in our services.

How would you rate your general health?
Do you have a sedentary job?
How often do you engage in physical activity outside of work?
Have you had a professional massage before?
Head and Neck
Nervous System
Respiratory
Respiratory
Cardivascular
Other Conditions
Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

Thanks for submitting!

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