Appointment Registration

Massage Registration

We have made this registration process simple and focused on your comfort. A few quick details help us prepare for your session safely and thoughtfully.

Before you begin What to bring, privacy, arrival tips

Before you arrive

Please arrive five minutes early, avoid heavy meals, wear comfortable clothing, and leave jewelry at home.

Your privacy matters

During registration, you may be asked to provide personal and health information. That information is only collected to support your care, is kept confidential, and is not shared outside your treatment plan.

Who should complete this form

New clients
Returning clients who have not visited in more than six months

Important reminders

Appointment required: Please book your session before completing this form.
Email confirmation: A copy of your completed form will be sent to your email address.
Print and bring: Please print your completed form and bring it to your appointment.
Need help? You may also complete the form in person before your appointment if needed, but please arrive early.

You can review our Massage Service Policy here.

Start by answering the question below, then click Next to continue.

Do you already have a scheduled appointment?

Yes

No

Please schedule your appointment first.

This registration form is for clients who already have a scheduled massage appointment.

Please call (757) 340-7132 to book your appointment, then return here to complete your registration.

Review Massage Service Policy

Appointment Date

Appointment Time

First Name

Last Name

Date of Birth

Phone:

Email

Referred By

Occupation and Daily Habits

Do you have any injuries, health conditions, or concerns we should know about before your massage?

Yes

No

How many weeks pregnant are you?

Are you currently taking any prescription medications?

Yes

No

Please list any medications you are currently taking.

Are you currently under the care of a doctor or other health professional?

Yes

No

Health Care Provider Name

Health Care Provider Phone

Agreement to General Liability Release

Please review the agreement below before submitting your registration form.

Acknowledgment of Risks: I understand that massage therapy may involve inherent risks, including temporary discomfort, soreness, or bruising.
Health Information: I confirm that I have provided accurate and complete information about my health, medical history, medications, and any injuries or conditions. I understand that not sharing relevant information may increase the risk of adverse effects during treatment.
Release of Liability: I agree to release and hold harmless Advanced Fuller School of Massage Therapy, Inc., d/b/a Fuller School, its owners, staff, students, and therapists from any liability for injuries, accidents, or damages resulting from massage services, except in cases of gross negligence or willful misconduct.
Personal Responsibility: I understand it is my responsibility to consult a physician before receiving massage therapy if I have concerns about my health.
Communication During the Session: I agree to inform the therapist immediately if I experience pain, discomfort, dizziness, or any adverse reaction. I understand I may request adjustments or stop the session at any time.

I have read and agree to the terms above and the Massage Service Policy.