Tanaz Hair Boutique & Day Spa Massage Form

Name *
Name
Cell Phone #
Cell Phone #
Emergency Contact #
Emergency Contact #
Have you ever received professional massage or body work? *
Are you currently experiencing pain from a traumatic experience (i.e. car accident, sports injuries, surgeries)? *
Are you currently taking any medications or supplements (prescription and non-prescription)? *
Are you pregnant? *
Select if you are currently or have had any of the following conditions. *
Health Information *I confirm that the above information is true and accurate to the best of my knowledge and give informed consent for my services at Tanaz Hair Boutique & Day Spa. *I give my consent for my therapist to treat me for noted purposes including techniques which may be recommended. *I acknowledge that the therapist is not a physician and does not diagnose illness, disease, or any other physical disorder. *I understand that no assurance or guarantee has been provided for the reults of the service. I acknowledge that with my treatment there can be risks and they may have been explained to me and I assume those risks. i understand that the therapist must be fully aware of my existing medical conditions and will provide updates of any new issues for future services.