Home About Me Contact / Location Massage Services Instruction / Consultation Policies Forms Links Phone: 434-409-3075 9 a.m. - 9 p.m. Email: aridaniels@massagetherapy.com	Ari Daniels, CMT Therapeutic Massage and Bodywork Forms Client intake form Before your first massage, please print this out, fill it in, and bring it with you so we can start the session on time. If you have any questions about this form, feel free to ask. Physician's referral form If you have any of the following health conditions, I also need a physician's referral form completed by your doctor. Pregnant (only second or third trimester — I will not work on a pregnant woman during the first trimester) Varicose veins, blood clots, or deep vein thrombosis (DVT) Recent head, neck, or spine injury (within two years) Cancer AIDS / HIV

Phone:
434-409-3075 9 a.m. - 9 p.m.
Email:
aridaniels@massagetherapy.com

Ari Daniels, CMT

Therapeutic Massage and Bodywork

Forms

Client intake form
Before your first massage, please print this out, fill it in, and bring it with you so we can start the session on time. If you have any questions about this form, feel free to ask.

Physician's referral form
If you have any of the following health conditions, I also need a physician's referral form completed by your doctor.

Pregnant (only second or third trimester — I will not work on a pregnant woman during the first trimester)
Varicose veins, blood clots, or deep vein thrombosis (DVT)
Recent head, neck, or spine injury (within two years)
Cancer
AIDS / HIV