Massage Clients Form Please fill out this form after Booking a Session. This information will help me to adapt the Session for your individual needs and wishes. Of course, your information will be treated confidentially and will not be passed on to third parties. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPronouns *They/ThemShe/HerHe/HisNoneEmail *What should be the focus of your massage *Stress ReliefPain ReliefNervous System RegulationDeep RelaxationOther (please tell me)Please detail any current or previous injuries or surgeries *if none please type „x“Please detail any allergies *if none please type „x“Please detail all Medication you‘re currently taking *if none please type „x“Please detail any current pain, tension or discomfort areas *if you have none please type „x“Please Check all that apply to you *contagious disease (e.g. HIV)feverinflammation (e.g. Appendicitis)Headache/ MigraneAnxietyDepressionburns / open woundsInguries (e.g. torn muscle fiber, ligament)Skin Disease (e.g. eczema, fungus)vessel disease (e.g. thrombosis, thrombophlebitis)heart diseasecancer / melanomahigh blood pressurelow blood pressureRheumatic diseases (e.g. ankylosing spondylitis)Neurological diseases (e.g. epilepsy, multiple sclerosis, spasticity)diabetesasthmaosteoporosisVaricose veinsOther (Please let me know)NoneDo you have any prostheses (knee, hip, etc.)? *if not please type „x“Are you pregnant ? If yes which month? *if not please type „x“ should Are If Are there any scents you don’t like or are allergic to? *if none please type „x“Is there anything else you want to let me know? *if not please type „x“Declaration *I AgreeI Disagree and by that cancel my booked sessionI hereby confirm that all information provided here is true and complete. I understand that a massage is intended for relaxation and not for the treatment of an illness, chronic condition, or other physical impairments or injuries. I have informed my masseuse about my health condition to the best of my knowledge. If my doctor or therapist has given me recommendations or restrictions regarding a massage, I have informed you of this. I agree that the massage is performed at my own risk and I have read the AGBSubmit