New patient - Oahu Sports Massage

Name *

First

Last

Date of Birth *

EXAMPLE: 01/14/1989

Address *

Address Line 1

City

State

Phone *

Email *

Email

Confirm Email

First Appointment? *

Check all that apply *

Brief description on what the issue is *

Pain Scale

Selected Value: 0

Terms & Conditions

Clear Signature

It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. I understand that the Oahu Sports Massage® has provided this form as a reference and is not held liable court or settlement of any kind for any and all services provided.