Wild Wellness
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    Massage Therapy Intake Form



    Medical History



    I understand, as massage therapy is both a medical and holistic healthcare profession, and in order to receive optimum treatment, the importance of my full disclosure. By entering my electronic signature below, I agree that all the information presented herein is comprehensively accurate to the best of my current knowledge. 
Submit

See you soon!


Studio Address:

Phoenix Reiki and Wellness
​14 Mt. Carmel Road

Parkton, Maryland 21120
  • Home
  • About
  • Wild Wanderings
  • Classes & Workshops
    • Shop Classes
    • Class Intake Form
    • Class Waiver