Account Registration

Massage History
Have you ever had a professional massage? Yes No
If yes, how often do you receive massages?
Do you have a usual pressure preference? Yes No
 
Light Pressure Medium Pressure Deep Pressure
Trigger Point Therapy Energywork  
Other:  
 
Are you sensative to fragrance or perfumes? Yes No
Do you have sensitive skin? Yes No
Do you exercise regularly? Yes No
 
What are your common areas of pain or tension?
Medical History
Do you suffer from chronic or persistante pain/discomfort? Yes No
If yes, for how long?
 
Do you know what caused it or when the symptoms starts to get worse?
 
Do you see a chiropractor? Yes No
If so, how often?
Are you currently under medical care? Yes No
Are you currently taking and medication? Yes No
 
If yes, for what?
 
Please select any conditions you have had or currently do have:
 
persistant headaches, migraines varicose veins  
allergies, sensativity pregnancy (currently)  
arthritis, tendonitis blood clots  
cancer, tumors neck, back injuries  
TMJ Problems diabetes  
abnormal skin conditions paralysis  
heart/circulatory problems fibromyalgia/myofascitis  
joint replacement / surgery numbness  
high / low blood pressure sprains / strains  
major accidents recent injuries  
other  
   
Please explain any conditions that you checked above:  
I have read, understand, and agree to the terms and conditions of the Essential Comfort Therapeutic Massage Policies.