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Bodywork Intake Form
The following information will be used to help plan safe and effective massage sessions. Please answer the questions to the best of your knowledge.

Please read and initial by each of the following statements:

Contraindications for massage



Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread Cancer. If undergoing treatment. If the client is currently undergoing any form of treatment for cancer then a doctor's note must be produced prior



Skin Problems

Skin Conditions. Some skin conditions such as severe acne, eczema, psoriasis, cold sores and open sores should prevent or restrict massage treatment Usually these problems are local, so massage may be administered in other areas of the body. As massage therapists usually do not wear gloves, skin conditions




Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly




A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma, or can develop slowly over time due to underlying disease processes such as diabetes mellitus, venous/arterial insufficiency, or immunologic diseas



Pregnant women, especially the first 3 months and 3 months after giving birth.



Bruising can occur for a variety of reasons, including thin blood, blood vessel problems, anemia, and thin or weakened skin Bruising; Inflammation, including arthritis; *Diagnosed Pain. *Depending on type of pain, region. Massage Therapists discretion with client consent. Local.


Liver Failure

It is absolutely not recommended to massage patients with Liver Failure. It is absolutely not recommended to massage a person who is suffering from Appendicitis



Cardiac Arrest

Arrhythmia Arrhythmia patients could be at an especially high risk when receiving a Heated Stone Massage. Cardiac, Liver or Kidney Disorders



Fever or pyrexia in humans is a body temperature above the normal range due to an increase in the body's temperature set point in the hypothalamus. There is no single agreed-upon upper limit for normal temperature: sources use values ranging between 37.2 and 38.3 °C in humans



Varicose veins

Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. These veins typically develop in the legs, just under the skin. Varicose veins usually cause few symptoms. However, some individuals may experience fatigue or pain in the area



Bone fracture

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture


Contagious diseases

General contraindications · systemic contagious or infectious diseases, including the common cold · acute conditions requiring first aid or medical attention Massage Contraindications & Precautions Every Therapist Should Know · Infection. · Contagious conditions which can have various causes, from viral to parasitic.



Abnormal Lumps

Severe Undiagnosed Pain, Lumps or Bumps unless written consent by a doctor; Lice or Scabies – Cancel and reschedule once it has been cleared up Regional. The Massage Therapist can undertake massage, however not over the affected areas/ 2nd trimester with pregnancy. Varicose Veins; Diagnosed Lumps


Diabetes not yet controlled

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects Diabetes – once cleared by GP – can be easily bruised and not able to feel if pressure is too hard due to loss of sensation in lower legs and feet



Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness Oedema – if a result of; liver or kidney disease, infection or trauma, toxaemia or heart failure. Medical contraindications – Treatment for the following



Emphysema; Severe, uncontrolled Asthma (if asthma is being managed then GP permission is not needed. Essential oil use may be restricted to avoid triggering Emphysema; Fibromyalgia;

Gastroesophageal Reflux Disease; Hernia; hypertension; Hyperthyroidism; Kyphosis; Lordosis;

Lupus Erythematosus; Lymphedema; Migraine Raynaud's Disease; Recent Head injury; Severe Asthma massage therapy contraindications; Severe Emphysema


High blood pressure not yet controlled

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms

Massage increases blood flow. If you have high blood pressure that is not under control, the increased blood flow that is a result of massage therapy



Inflammation is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function



A burn is an injury to skin, or other tissues, caused by heat, cold, electricity, chemicals, friction, or ultraviolet radiation. Most burns are due to heat from hot liquids, solids, or fire. Burns occur mainly in the home or the workplace Cuts or open wounds; Bruises; Varicose veins; Broken bones; Burns; Some skin conditions. If you have these massage contraindications and you want a massage you



Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. An epileptic seizure is the clinical manifestation of an abnormal, excessive, and synchronized electrical discharge in the neurons. The occurrence of two or more unprovoked seizures defines epilepsy




Chronic or Long Standing Thrombosis; Conditions of Spasticity (Cerebral palsy, Hemiplegia, MS, spinal cord injury); Conditions of Rigidity such as Parkinsons



Severe Hemophilia; Advanced Kidney Failure; Respiratory Failure. Liver Failure; Appendicitis; Highly Metastatic Cancers eg. lymphoma, malignant melanoma Hemophilia; Hodgkin's disease; Kidney stones; Leukemia; Myasthenia gravis; Nephrosis; Peritonitis; Polycystic kidney disease; Uremia. Massage Contraindications

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Helpful Information

Welcome to our Help Center. Take a look at some of the most common questions we’ve received from our customers. If you still have something you’d like to know, let us know and we’ll get back to you shortly.

Are you open during the holidays?

Enter your answer here. Be thoughtful, write clearly and concisely, and consider adding written as well as visual examples. Go over what you’ve written to make sure that if it was the first time you were visiting the site, you’d understand the answer.


What does general admission include?

performs authentic and traditional Thai massage to restore the health of the body. It also recreates the natural harmony of all aspects of the human body. They also use natural methods and products for their services. Furthermore, they employ certified practitioners. they are interested in Acro yoga and yoga. They integrated Thai massage, Thai oil massage, and Hot stone massage. Moreover, their services include traditional Thai bodywork and massage, Thai swedish massage massage, and Thai Aroma massage compress. They also have head and deep tissue massage as part of the traditional Thai massage. Their sessions run between 60 to 90 minutes.


Are your facilities accessible to people with disabilities?

Enter your answer here. Be thoughtful, write clearly and concisely, and consider adding written as well as visual examples. Go over what you’ve written to make sure that if it was the first time you were visiting the site, you’d understand the answer.

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