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SERVICES
I CANDY BY CANDY ONEAL
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Massage Form
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First name
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Last name
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Today's date
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Address
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Birthday
Month
Month
Day
Year
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Phone
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Email
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Emergency Contact Name
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Emergency Contact Phone Number
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Have you had a professional massage before?
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No
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Is this your first visit to Contours Day Spa?
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No
If yes, how did you hear about us?
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If other, please explain
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Are you currently taking any medication(s)?
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No
If other, please explain
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Have you had a recent major surgical procedure or injury?
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No
If yes, please explain
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Are you currently seeing a chiropractor, physical therapist or physician?
Yes
No
If yes, please explain:
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Do you have any allergies to any lotions, oils or nuts?
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Are there any areas you are holding tension today?
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Are there any areas you would not like massaged?
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