Forms to Complete

Kindly take a moment to provide me with the following information so that I may maximize the effectiveness and safety of our sessions together. All information provided by you will be kept confidential. You may fax (1.512.233.5361) or mail the completed forms to me (11506 Oak Knoll Drive, Austin, Texas 78759). Faxing is the most secure way to send me information; only I see your documents. Email is another way to send your forms; my email address is geri@tworoadsmassagetherapy.com

Which forms do I complete?

First-time clients: Please download, complete and bring the form(s) and any other necessary documents, information (such as list of medications, etc.) with you to your first appointment. It would be very helpful if I could have the completed forms BEFORE your first massage with me. You may fax (1.512.233.5361), email (geri@tworoadsmassagetherapy.com) or mail the completed forms to me (11506 Oak Knoll Drive, Austin, Texas 78759).

If you are a client living with cancer, please print and complete BOTH forms listed below.

Note: If you are currently in treatment, between treatments or if your last treatment was within one year of the date of our anticipated massage session, I need to have your physician complete an "acknowledgment/special instructions letter." Call me at 512.576.1050 for a copy of this form.

If you are a client who has NOT had any cancer, please print and complete only ONE form: the Client Intake Health History Form. Please remember to bring the forms with you to your first massage session! Thank you.

Client Intake Health History Form

This two-page form is for all NEW clients (oncology and not-oncology).

Client Intake Oncology History Form

This three-page form is for clients living with cancer. For those who are going through treatment, a "Physician Release" form is also needed. Please call me at 512.576.1050 so I can explain further.

Note: To download Adobe Acrobat Reader for free, click here.