Appointment Registration

Welcome

We have designed this registration process to be simple and focused on you. A few quick details help us tailor your massage safely and respectfully.

Read important details Privacy, who this is for, what to bring

Before You Arrive

Preparation time is part of your appointment. Please arrive five minutes early, avoid heavy meals, wear comfortable clothing, and leave jewelry at home.

Your privacy matters

During registration, you will be asked to provide some personal and medical details. That information is:

Only collected to support your care
Always kept confidential
Not shared or used outside of your treatment plan

You always decide what you want to share.

Who should complete this form

New clients
Returning clients who have not visited in over six months

Before you begin

Appointment required: Please book your session before filling out this form.
Email confirmation: After you submit, a copy will be sent to your email address.
Print and bring: Please print your completed form and bring it to your appointment.
Option to complete in person: If needed, you may complete this form in person before your appointment, but please arrive early to allow enough time.

Completing this ahead of time helps reduce paperwork and gives you a smoother, calmer start to your session.

After you register

You will receive a confirmation email with your appointment details
Your therapist will use your information to tailor your care to your needs
You will arrive ready to relax, knowing everything has already been taken care of

Our commitment to excellence

We are proud to be an Approved Provider with the National Certification Board for Therapeutic Massage and Bodywork. Learn more about these standards.

To review our Massage Service Policy, click here.

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

Do you have a scheduled appointment?

Yes

No

Thank you for being proactive. Before you can complete this form, we need to schedule your appointment first. Please call 757-340-7132 to set it up, and then you can return here to finish your registration.

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 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 any concerns regarding my health.
Communication During the Session: I agree to inform the therapist immediately if I experience pain, discomfort, dizziness, or any adverse reaction, and I understand I may request adjustments or stop the session at any time.

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