Mend & Grow, LLC
Home About Contact
Book Appointment Bodywork Intake Form
Bodywork Modalities Fitness training & Corrective Exercise Primal Health Coaching Corporate Programs
HomeAbout Holistic Solutions Bodywork Modalities Fitness training & Corrective Exercise Primal Health Coaching Corporate Programs Contact
Mend & Grow, LLC
Book AppointmentBodywork Intake Form

 

Name *
Phone # *
How did you here about us? *
Please select one
We love referrals!
Client Intake Form
Please check off any condition below that applies to you:
What areas of the body need focus?
Select all that apply
If I experience any pain or discomfort during the session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician or other qualified medical specialist for any mental or physical illness of which I am aware. I understand that massage practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage should not be performed under certain conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to 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. Understanding all of this, I give my consent to receive care. CLIENT SIGNATURE (Type Full Name)
Date *
Thank you!
Mend & Grow
2660 28th Street,
Sacramento, CA, 95818,
United States
91659888947 info@mendandgrow.com
Hours
Mon Closed
Tue 11am-7pm
Wed 11am-5:30pm
Thu 11am-7pm
Fri 11am-7pm
Sat Closed
Sun Closed

Mend & Grow, LLC
2955 3rd Avenue, Suite#204, SACRAMENTO, CA
(916) 598-8847 - info@mendandgrow.com

A.R.T.#451042-09 CAMTC#64066 ACE#T232613 PHC#19446276