Patrick Stockstill, Esalen® Massage
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Client Intake and Consent
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Emergency Contact
Check any that currently apply to you
blood clots
infection
congestive heart failure
contagious disease
edema
What brings you in for massage? Please list and prioritize areas of concern
Are there any areas of your body you prefer not to have touched? (Scalp, face, feet, abdomen, etc.)
Would you recommend us to your friends?
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