Health Declaration

First Name

Last Name

Email

*I am NOT currently sick or having Covid related illness (if you're sick please reconsider)

I have a special request for massage lotion, oil, no lotion or oil product use, bed heated

No

Yes

Date

Initials

I confirm that the information given in this form is true

I agree to all the terms & conditions of My Healing Hands Massage

Thanks for submitting!

Please arrive 10 min before your schedule session for completion of your intake form (required)