River Oaks THAI MASSAGE

CLIENT INTAKE & WELLNESS FORM

Help us personalize today’s massage for your comfort and well-being.

GUEST INFORMATION

First Name *

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Last Name *

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Phone Number *

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Email *

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Date of Birth

First Visit?

Yes No

Emergency Contact

Emergency Contact Phone

YOUR MASSAGE PREFERENCES

Preferred Pressure Level

LIGHTGentle, soothing touch MEDIUMBalanced pressure FIRMFocused deeper pressure DEEPIntensive pressure

Pressure can be adjusted at any time for your comfort.

Massage Style Preference

RelaxationGentle, calming experience TherapeuticTension relief & recovery Thai StretchingAssisted stretching & mobility CombinationA blend tailored to your needs

Thai Bodyweight Technique (Thai Walking / Back Walking)

Yes No

YOUR HEALTH & SAFETY

Please let us know of any conditions so we can provide a safe, comfortable, and personalized experience.

Please select any conditions that may apply:

Recent injuries or surgeries Fractures High blood pressure Arthritis Heart condition Varicose veins Diabetes History of stroke Blood clots or circulation issues Chronic pain or medical condition Pregnancy Currently taking medications Skin conditions or allergies None of the above Osteoporosis

Anything the therapist needs to know?

Additional Notes:

TODAY’S SESSION

What are your goals for today’s session?

Relax Recovery Relieve Tension General Wellness Improve Mobility

Other:

Title

AREAS OF FOCUS

Circle areas where you would like additional attention.
Mark an X over any area you would like your therapist to avoid.

Use your finger or Apple Pencil

Front, back, left side and right side body focus diagrams

Select Specific Areas:

Head & Scalp Lower Back Full Body Focus Neck & Shoulders Legs & Feet Upper Back Arms & Hands

Areas to Avoid:

Title

ENHANCE YOUR EXPERIENCE (OPTIONAL)

Select Your Enhancements:

Thai Herbal Balm Aroma Oil Thai Herbal Compress Aroma Candle Massage CBD Oil Hot Stone Cupping Therapy Singing Bowl None Today

Aromatherapy

Yes, I’d like aromatherapy No, thank you

Select Your Scent:

Lavender — Deep Relaxation Jasmine — Mood Enhancing Lemongrass — Fresh & Revitalizing Rose — Calming & Balancing Citrus — Energizing & Uplifting Sandalwood — Grounding & Warmth

Enhancement selections indicate interest only and are not automatically added or charged.

CONSENT & POLICIES

Massage services are provided for relaxation and wellness purposes and are not a substitute for medical diagnosis, treatment, or care.

Professional behavior is required at all times. Inappropriate or sexual behavior will result in immediate termination of the session.

A minimum of 24 hours’ notice is required for cancellations. Late cancellations may forfeit the deposit, and no-shows may be charged 100% of the service. Sales are final and services are non-refundable.

By proceeding, the guest confirms that relevant health information has been disclosed and agrees to communicate discomfort or concerns to the therapist.

I HAVE READ AND AGREE TO THE CONSENT & POLICIES ABOVE. I AGREE TO USE ELECTRONIC RECORDS AND SIGNATURES.

Guest Full Name:

Date:

Signature:

Sign here

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