AdZenture | Mobile Massages Experience Total Zen

Are you taking any medication? *

Yes

No

If yes, please list:

Do you have any medical conditions? (If yes, we advise that you consult your doctor before your appointment.) *

Please provide details for any selected conditions:

Are you currently pregnant? *

Yes

No

If yes, how far along?

Do you suffer from any chronic pain? *

Yes

No

If yes, please explain what makes it better/worse:

Have you had any orthopaedic injuries? *

Yes

No

If yes, please list below:

Massage Pre-Screening Form