Patient Info

MM slash DD slash YYYY
Where did you hear about Traditional Thai Massage & Wellness?(Required)

Please check if you have any of the following conditions(Required)
How often you get a massage:(Required)
All information given is strictly confidential and will not be used for any purpose I ALSO UNDERSTAND THAT THIS IS STRICTLY PROFESSIONAL THERAPEUTIC MASSAGE. ANY INAPPROPRIATE TOUCHING OF THERAPIST OR BEHAVIOR, ANY ILLICIT OR SEXUALLY SUGGESTIVE REMARKS OR ADVANCES WILL NOT BE TOLERATED. THE RESULT OF SUCH WILL BE IMMEDIATE TERMINATION OF THE MASSAGE SESSION, WITH COMPLETE PAYMENT FOR APPOINTMENT MADE
I agree to terms of this form(Required)