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CALM Medical Intake Form

Please fill out the following form to the best of your ability.

Have you had a professional massage before?
What type of massage are you seeking?
What pressure can you tolerate?
Do you have any allergies or sensitivities to lotions or products?
Are there any areas (feet, face, abdomen, etc.) you do not want massaged?
Are you having pain?
Pain levels 0-10: (0- is no pain, 10- need to go to the hospital)
Please Check any that apply:

Thanks for submitting!

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