New Client Intake Name * First Name Last Name Email * Phone * (###) ### #### Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Emergency Contact Name * First Name Last Name Emergency Contact Phone No. * (###) ### #### Reason for Massage * Any injuries, allergies, or preexisting conditions? * Terms & Conditions * The information I've provided is accurate to the best of my knowledge. I freely give my permission to be massaged, and I agree to inform the therapist of any experience of pain during the session. I understand this does not deter me from seeking medical treatment for medical conditions. I understand that no inappropriate comments or conduct will be tolerated. Any indication of such behavior will automatically end the session. I agree to update the massage therapist in regard to changes in my health and understand that there shall be no liability on the therapist's part should I forget to do so. I agree to hold Like A Boss Massage harmless from any and all claims. I agree to handle suit at its sole expense and agree to bear all costs related even if claims are groundless, false, and fraudulent. I have read and agree to the terms above. Thank you! We’ll be back in touch via email ASAP.