Power Thai Massage Intake Form
By completing this form I affirm my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage.

I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis.

I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. I understand that Milo Thai Massage LLC has provided this form as a reference and is not held liable for any services provided.
Email address *
Next
Never submit passwords through Google Forms.
This form was created inside of Milo Pilaspilas.