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Client Massage Health form

Manaia Wellness

Please take a minute to fill in the following information. This helps us to determine the treatment is right for you. Please sign when you understand, have read and completed this questionnaire truthfully and understand withholding information or providing mis information may result in contraindications from treatments received. I agree to inform my therapist if any of the information changes at anytime. I understand that my therapy provided by my therapist does not constitute medical treatment

Do you have any of the following?Please tick the box for a yes answe
Please tick the box for a yes answer. What massage pressure do you prefer?
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