Your Details


    Health Details

    Do you suffer from chronic pain?

    Please check all that apply * Pregnant PostpartumNeck PainBack Pain HeadachesHigh Blood PressureBruise EasilyDiabetesSeizuresKnee/Leg PainJaw Pain / Clenching/ GrindingMetal ImplantsFibromyalgiaCancerArthritisNeuropathyStrokeHeart AttackKidney DysfunctionBlood ClotsNumbnessSprains / StrainsNone of the above

    Massage Preferences

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    Have you had a professional massage before?

    What type of treatment are you looking for?

    What pressure do you prefer?

    Do you have any allergies or sensitivities?

    Terms & Conditions



    1) I give my permission to receive massage services.
    2) I understand that therapeutic massage is not a substitute for traditional medical treatment or medications.
    3) I understand that Auraflow Fitness and Therapies does not diagnose illnesses or injuries, or prescribe medications.
    4) I have clearance from my Doctor to receive massage therapy.
    5) I understand the risks associated with massage therapy include, but are not limited to:
    • Superficial bruising or redness
    • Short-term muscle soreness
    • Exacerbation of undiscovered injury
    I, therefore, release Auraflow Fitness and Therapies from all liability concerning these injuries that may occur during the massage session.
    6) I understand the importance of informing Auraflow Fitness and Therapies of all medical conditions and medications I am taking and to let Auraflow Fitness and Therapies know about any changes to these. I understand that there may be additional risks based on my physical condition.
    7) I understand that it is my responsibility to inform Auraflow Fitness and Therapies of any discomfort I may feel during the session so she may adjust
    8) I understand that I or Auraflow Fitness and Therapies may terminate the session at any time.
    9) I have been given a chance to ask questions about the session and my questions have been answered.


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