Appointment Registration

Welcome

We’ve designed this registration process to be simple and focused entirely on you. The more we understand your health history, preferences, and goals, the better we can tailor your massage — safely, respectfully, and effectively. Whether it’s your first visit or your first in a while, we’re here to ensure your experience starts off smoothly.

Your Privacy Matters

We take your trust seriously. During registration, you’ll be asked to share some personal and medical information. This information is:

Collected only to support your care
Kept 100% confidential
Never shared or used for anything outside of your treatment plan

You are always in control of what you share.

Who Should Complete This Form

New clients
Returning clients who haven’t visited in over 6 months

Before You Begin

Appointment required: Please schedule your session before completing this form.
Email confirmation: After submitting, you’ll receive the form via email.
Print & bring: Print out your form and bring it to your appointment.

Taking care of this in advance means less paperwork and a more peaceful start to your session.

After You Register

Here’s what to expect next:

You’ll receive a confirmation email with appointment details
Your therapist will use your information to personalize your care
You’ll arrive ready to relax, knowing everything is in place

We believe a great massage begins before you even walk through the door. That’s why we’ve made this process smooth and stress-free.

Our Commitment to Excellence

As an Approved Provider by the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB), 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.

Answer the question below to start, then click Next to continue.

Do you have a scheduled appointment?

Yes

No

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:

Email

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

No

Please let us know how many weeks pregnant you are.

Are you currently taking any prescribed medications?

Yes

No

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

Are you currently under the care of a health professional?

Yes

No

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.