1. Have you had a professional massage before?
Yes No

2. Have you ever had surgery?
Yes No

3. Do you wear contact lenses?
Yes No

4. Do you have skin problems or allergies?
Yes No

5. Do you take prescribed medication?
Yes No

6. Have you suffered an acute injury recently?
Yes No

7. Do you have varicose veins or blood clots?
Yes No

8. Do you have arthritis?
Yes No

9. Do youy have any heart problems?
Yes No

10. Do you have blood pressure problems?
Yes No

11. Do you have any spinal problems?
Yes No

12. Do you excerice regulary or participate in any sports?
Yes No

13. Do you have any other medical conditions of which your therapist should be aware before giving you a massage?
Yes No

14. Are you pregnant?
Yes No