Client Intake Forms | Lake Side Care Con 1

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Neck Massage Therapy

Massage Client Intake Form

First name

Last name

Email

Phone

Address*

Billing Address

Address*

Address of Lake Property with Lot Number

Number*

Best Phone Number

Which Massage Service are You Scheduling?*

Please list any medical conditions, injuries, surgeries, or areas of pain I should be aware of before your massage.*

Please list all medications you currently take, including blood thinner, pain medications, and supplements. If none, enter N/A*

Emergency Contact--Full Name and Relationship*

Emergency Contact Phone Number*

Do you have any allergies or sensitivities to lotions, oils, fragrances, latex, or other products? Please explain. If none, enter N/A*

Are you currently pregnant, recovering from surgery, or receiving medical treatment for any condition? Please provide details, including any restrictions. If none, enter N/A*

Do you have any areas you would like me to focus on or avoid during your massage? Do you prefer light, medium, firm, or deep pressure?*

I understand that massage therapy is intended for relaxation and muscular relief and is not a substitute for medical diagnosis or treatment. I agree to inform my massage therapist of any changes in my health and understand that i may request changes or stop the massage at any time.

I understand and consent.

Signature*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date*

Month

Day

Year

I authorize Liz Overstreet, LMT to provide massage therapy at my home or designated location. I understand that I am responsible for providing a clean, safe, and accessible space for the appointment.

I understand and agree.

I understand that appointments should be canceled or rescheduled with at least 24 hours notice whenever possible. I agree to notify Liz Overstreet as soon as possible if I need to change my appointment.

Are you currently experiencing any fever, illness, contagious conditions, unexplained swelling, blood clots, open wounds, or any other health concerns that could affect your massage? Please Explain. If none, type N/A.*

I understand that the personal and health information provided on this form will be used for massage intake, safety, and treatment planning. My information will be kept confidential except when disclosure is required by law or authorized by me.

Massage Appointment Location*

At My Home (In-Home Massage)

At Liz's Lake Home

Event Chair Massage Location

If receiving an in-home massage or event chair massage, please provide the full address, including any gate codes or special arrival instructions. If receiving massage at Liz's Lake Home enter N/A.*

Lake Side Care & Concierge Authorization Forms.

Access all necessary documentation for property maintenance and concierge service agreements. Ensure your lakeside retreat is fully managed and ready for your arrival.

Goose Creek Lake, Missouri

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Providing premium property care and lake-day readiness for Goose Creek Lake homeowners.

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