Client Intake Form

Please note N/A if not applicable

Please note N/A if not applicable

Please note N/A if not applicable

It is my choice to receive massage therapy. I am aware of the benefits and risks and give my consent for massage. I understand that there is not implied or stated guarantee of success or effectiveness of individual techniques or series of appointments. I acknowlege that massage therapy is not a substitute for medical care, medical examination, or diagnosis. I have stated all medical conditions that I'm aware of and will inform my practitioner of any changes in my health status.

I understand that my personal health information will be collected. I understand that all information that I provide will be kept confidential unless required by law. I understand and consent that my medical information may be shared by the various care providers involved in my care and treatment.

Mano y Mano Holistic is committed to maintaining a professional and safe environment, free from all forms of sexual misconduct. Any unwelcome behavior—including but not limited to inappropriate comments, gestures, staring, or physical contact—will not be tolerated and will result in permanent dismissal from Mano y Mano services and facilities.