INTAKE FORM Name * First Name Last Name Email * Phone * (###) ### #### Have you had a serious or chronic illness, injury or surgery? * Yes No Are you taking medication for blood clotting or thinning? * Yes No Do you have any skin allergies? * Yes No Are you pregnant? Yes No Massage Preferences * Choose one Traditional Thai Deep Tissue Swedish Combination Pressure * Choose one Light Medium Hard Concentration * Check all that apply Neck Shoulder Back Waist Arms Legs Feet All of the above By clicking "I Agree", I release Sabaidee Thai Massage and Spa of any and all liability of any kind arising from any connection with the massage. * Yes, I agree to these terms Date * MM DD YYYY Thank you!