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Give the gift of tranquility! Gift certificates are now available.
 
   
 
 
New Client Info

If you are a first time client, please fill out this form and select the Submit button. It lets me know massage-pertinent information about you, so that you’ll get the most out of your session. If you have any questions, please call 510-268-0443 or email me.

Your privacy is important to me. I will not share any of your information with third paries, unless requested to do so by you.

 

First Name *
Last Name *
Home Street Address *
City, State and Zip Code *
Email *
Phone Number *
Birthdate

 
How did you hear about us? (Yelp, a current client, ect.) *
What's your profession? Does your job involve computer time, heavy lifting, frequent airline travel or driving?
Have you ever experienced a professional massage? *
Do you have frequent headaches?
Do you bruise easily (from massage)?
Are you pregnant?
If yes, how many weeks pregnant are you?
Do you have numbness, a tingling sensation, or stabbing pains anywhere? Please describe the location and sensation.
Where do you commonly hold tension?
Important! Please list any allergies you have that might be triggered in a massage setting, or by ingredients in massage lotion or oil. *
Have you been in any accidents, broken any bones, or had any major injuries in the past two years? Have you ever dislocated a joint? If so, please describe.
Do you have any of the following... high blood pressure, arthritis, diabetes, osteoporosis, varicose veins, cardiac or circulatory problems, epilepsy, or seizures? Please list.
Have you ever had surgery? If so, in what area, and approx. how long ago?
Are you taking any of the following medications or natural supplements: steroid shots, anticoagulants, heart medications, anti inflammatories, or aspirin? If so, please list.
Do you have any other medical conditions, or is there anything else your massage therapist should know?
I'd like to receive Andrea's monthly newsletter, which contains evidence-based health info designed to make me feel better between massages, and sometimes special offers on massage.

 
Please read and type your name here for consent. *
Good Massage Feels Good If I experience any discomfort during my session, I will inform my massage therapist.
Allergies I understand that if I have an undisclosed allergy to any ingredients used, known or unknown to me, I can not hold my therapist responsible for reactions to massage products. However, I will contact Andrea Turner CMT if any reactions occur so that the product manufacturer can be informed. (Please type your name here for consent.)
Full Disclosure Because massage should not be performed under certain conditions, I have stated all my known medical issues. I understand that massage therapy is not a substitute for a medical exam or diagnosis, and therefore any conditions that I haven not explicitly stated can not be taken into account during my session. I agree to keep my massage therapist updated if there are changes in my medical profile, and there shall be no liability to my massage therapist or Andrea Turner CMT if I fail to do so.
Policies I have read, understand and agree to all of the policies (regarding allowable timing for appointment cancellations, and consequences for 'no shows', for example) listed on the policy page of this website.




 
 
Andrea@AndreaCMT.com        585 Mandana Blvd. Suite 3, Oakland, CA
510-268-0443