Massage Registration

Massage Service Registration

Newsletter

Appointment Validation
Appointment Date and Time
Client Information
Occupation / Habit
Prescription Information
Physician Information
Terms and Conditions

Registration for a Massage

Introduction

To ensure that you receive the best possible experience, we have made the registration process straightforward and efficient. Clear communication about your health history, preferences, and expectations allows us to create a personalized and safe treatment tailored specifically to your needs. Whether you’re a new client or returning after a break, our focus is on providing you with a professional and respectful environment.

Your Privacy During Registration

Your privacy is our top priority. Any personal information shared during the registration process, including medical details or health history, will be treated with strict confidentiality. This information is used solely to provide the best care and ensure a comfortable, safe, and tailored massage experience. We are committed to safeguarding your trust and confidence throughout the entire process.

Steps for Registration

New Customer or Returning After 6+ Months: If you are new to us or it has been more than 6 months since your last visit, please complete this form.
Appointment Required: You must have a scheduled appointment before filling out this form.
Next Steps: You will receive the completed form via email. Kindly print it from your email and bring it with you to the appointment.

By completing the registration process in advance, we can focus on providing a smooth and relaxing session when you arrive.

What to Expect After Registration

Once your registration is complete, you will:

Receive an email confirmation with your appointment details.
Be prepared for a personalized experience that takes your preferences and needs into account.

Our goal is to make the registration process easy so you can relax and focus on the benefits of your massage.

Our Commitment to Excellence

As an Approved Provider by the National Certification Board for Therapeutic Massage & Bodywork (NCTMB), we are committed to meeting the highest standards of professionalism and care. Learn more about these standards here.

This dedication ensures that every client enjoys a massage experience delivered by skilled professionals in a welcoming environment.

To review our Massage Service Policy, click Here.

Do you have a scheduled appointment?

Yes

Thanks for being awesome and proactive! But before you can fill out this form, we just need to schedule an appointment. Give us a call at 757-340-7132 to set it up, and you will be all set to go!

To review our Massage Service Policy, click Here.

Appointment Date

Appointment Time

First Name

Last Name

Date of Birth

Phone:

Referred By

Occupation / Habits

Do you have any recent or past injuries or conditions (e.g., pregnancy, sports injury, etc.) that could impact your massage treatment?

Yes

Select all that apply:

Acute Pain

Allergies

Cancer

Chronic Pain

Circulatory Disease

Diabetes

Emotional Changes

Flu / Cold

Headaches

Heart Aliments

High Blood Pressure

Infectious Disorder

Osteoporosis

Phlebitis

Sinus Disorders

Sports Injury

TMJ syndrome

Varicose Veins

Pregnant

Please let us know how many weeks pregnant you are.

Are you currently taking any prescribed medications?

Yes

Please provide the names of any medications you are currently taking.

Are you currently under the care of a health professional?

Yes

Physician Name:

Physician Phone:

Agreement to General Liability Release

By receiving massage therapy, I acknowledge and agree to the following:

Acknowledgment of Risks: I understand that massage therapy involves certain inherent risks, including discomfort, soreness, and bruising.
Health Information: I confirm that I have provided accurate and complete information regarding my health, medical history, and any injuries. I understand that withholding relevant health information may pose risks 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 the massage treatment, except in cases of gross negligence or willful misconduct.
Personal Responsibility: I understand that it is my responsibility to consult a physician prior to receiving massage therapy if I have concerns about my health and well-being.

I confirm my understanding and agreement to the terms outlined above and in the Massage Service Policy.