New Client Form

New Clients

Please fill this form out before booking your first appointment.

Questions?

Ariel@deltaemwellness.com

(856) 335-5902

Agreement

Sessions including Massage, Sound Healing, Aromatherapy, Energy Healing or any of our services is not suitable for medical attention, examination, diagnosis or treatment. Certain medical conditions are not safe or treatment would need to be modified. Examples include: high blood pressure, arthritis, diabetes, surgeries (include past surgeries) , skin condition, headaches. By filing out this form you are affirming "I affirm that I alone am responsible for my well being and it is my decision to receive a session. If there is any question or concern I will see my doctor beforehand. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Delta EM Wellness, and all associated locations. Because massage/bodywork should not be performed under certain medical conditions, I affirm that I will state all known medical conditions. I agree to keep the practitioner updated as any changes in my medical profile and understand that there shall be no liability on the practitioner's part should I fail to do so.

Full Name:

Address:

Phone:

Email:

Do you have any session goals or intentions for today's session? (optional)

Any additional concerns, preferences or areas to avoid?

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