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Is this a gift certificate?*
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Have you had a massage/bodywork before?*
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Reasons for seeking massage? (relaxation, injury, etc.)*
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Expected outcomes (functional improvement, symptom relief, wellness):*
Typical activities of daily living (affected by condition?):
Occupation (affected by condition?):
Best times for massage:*
Do you now, or have you recently had, any chills, muscle aches, new loss of taste or smell, or new rashes or lesions?*
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Have you been in contact with anyone in the last 14 days who has been diagnosed with COVID-19 or has coronavirus-type symptoms?*
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Do you have special needs I should prepare for:*
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