Massage and Bodywork Intake Form I understand that a massage therapist can not diagnose illness, disease, or any other medical. physical, or emotional. Client Intake Form – Therapeutic Massage. Personal Information: Name. Phone (Day). Phone (Eve). Address. City/State/Zip email. Date of Birth. Occupation. This form was created as a resource by the american massage therapy association® and they are not held liable for any services provided. client intake form.
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