Layers Wellness & Spa
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Massage Intake Form

1Contact Info
2Massage Info
3Medical History
4Conditions
5Consent
  • Contact Information

  • DD slash MM slash YYYY
  • NamePhone 
  • Massage Safety Questions

    The following information will be used to help plan safe and effective massage sessions. Please answer the questions to best of your knowledge.
  • Medical History

    In order to plan a massage session that is safe and effective, please provide some general information about your medical history.
  • MedicationDosage 
  • Medical Contitions

    Please check any condition listed below that applies to you.
    Please explain any condition that you marked above with your massage practitioner prior to your session.
  • Consent

  • • I understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort.
    • I understand that although massage can be therapeutic, it is not a substitute for medical examination, diagnosis, or treatment.
    • I affirm that I have stated all my known medical conditions and answered all questions honestly.
    • I agree to keep the therapist updated as to any changes in my medical profile.

    We require 12 hours notice to cancel or reschedule an appointment. Failure to do so will require a $50.00 no-show fee.

What our guests have to say

PH: 780.750.6888
OR 780.750.6848

EMAIL: INFO@LAYERSWELLNESS.COM
BOOKING: BOOKING@LAYERSWELLNESS.COM

UNIT #4 – 100 REAL MARTIN DRIVE
FORT MCMURRAY, AB T9K 2S1

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HOURS OF OPERATION
MONDAY TO FRIDAY: 9AM – 8PM
SATURDAY: 9AM – 5PM
SUNDAY: 10AM – 5PM

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