Reflexology Massage Therapy Services Consent FormPlease take a moment to fill out the form.MUST BE COMPLETED & SIGNEDBEFORE RECEIVING A MASSAGE First Name:Last Name:Email address*Birthday:Have you ever experienced a professional massage?YesNoWhich areas would you like to focus on during this massage?High blood pressure.*Do you have any of the following conditions? If yes, please explain below as clearly as possible. *Contagious diseaseAllergiesDiabetesWear contact lensesBack painPregnantCancerCardiac/circulatory problemsArthritisVaricose veinsSensitive to touch/pressureFrequent headachesHigh blood pressure.*Surgery in the past 5 years?*Accident or suffered any injuries in the past 2 years? Broken bones, etc.*Other medical conditions not listed*By Typing Your name you agree for the information above to be factual.*SendThis field should be left blank