Phoenix Women's Health Massage Info & Consent FormHelp me help you! Name * First Name Last Name Email * Phone * (###) ### #### Birth Date * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency contact name and phone number * How did you hear about us? * What is your intention for todays visit? Please list and health concerns: * What is your current birth control method? * Any past history of herpes, UTI or STDs? * Are you under emotional stress at this time? * Are you on prescription medications or supplements? * Do you have any allergies to any oils or herbs? * What are your overall health goals? * Are you open to intuitive messages? * Cancellation Policy * We understand that emergency situations may arise, and these will be handled in a case-to-case basis. For cancellations, please allow 24 hours prior to your scheduled appointment time. Late appointments will be deducted the time from your scheduled appointment without interference to the following appointment time. Do you agree to this policy? I agree Thank you for submitting the info and consent form!
