Health declaration

Please fill out the following form.

First name

Last name

Email*

Date of birth

Month

Day

Year

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

Disclaimer:

Massage by Lyn provides professional, non-medical therapeutic bodywork for relaxation and muscular wellness. Services are not a substitute for medical care, diagnosis, or treatment. Please consult your physician if you are under medical supervision.

Massage by Lyn reserves the right to refuse or end any session due to inappropriate conduct, intoxication, or health conditions outside the scope of practice. Sexual misconduct or solicitation is strictly prohibited.

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