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Client Intake Form

Sirius Health

Welcome to the Sirius Health Thai massage clinic.

Please help us serve you by completing this Intake Form in advance.

Basic Information

Contact Information

Issues to Address

Existing Conditions

Client Waiver Form

Please take a moment to read and initial the following information:

I have informed the Thai Massage Therapist of all my known physical/medical conditions and medications. I will keep the Thai Massage Therapist updated on any changes to my health history.

The Thai Massage Therapist explained to me and I understand:

  • why a health history is needed before Thai massage begins
  • that I may aske questions about the information being requested and my therapy any time
  • that all client informations is confidential and written authorization will be obtained prior to release of information to other caregivers
  • the general benefits of the Thai massage treatment, possible massage contraindications and precautions
  • the assessment and treatment procedures, techniques and remedial exercises employed
  • the body areas to be massaged
  • that draping will be used to expose only those areas that require treatment
  • that at any time, I may withdraw my consent and treatment will be stopped
  • the duration and cost of the Thai massage treatment
  • that Thai massage therapy is not a substitute for medical treatment or medications
  • that it is recommended that I work with my Primary Caregiver for any condition i may have
  • that a Thai Massage Therapist does not diagnose illness or disease and does not perscribe me

By signing this release, I hereby waive and release my therapist from any and all liability from problems arising from the treatment as a result of information not given or incorrectly given in this client history form.

Thai Massage

  • Address:
    105 - 412 Avenue C South
    Saskatoon, SK, S7M 5N7
    Canada
  • Hours:
    Monday-Friday: 9 a.m. - 9 p.m.
    Saturday: 9 a.m. - 5 p.m.
    Sunday: Closed

Contact Us

  • Telephone:
    +1 306 700 5115
  • Email:
    This email address is being protected from spambots. You need JavaScript enabled to view it.

Transportation

  • Bus:
    Route 9 Riversdale - Stop 5758
    Route 9 City Centre - Stop 5755
  • Parking:
    On street

Fitness Studio

  • Address:
    101 - 410 Avenue C South
    Saskatoon, SK, S7M 5M7
    Canada
  • Hours:
    Monday-Friday: 7:30 a.m. - 8 p.m.
    Saturday: 9 a.m. - 5 p.m.
    Sunday: 1 - 5 p.m.
Copyright © 2020 Sirius Health Inc. All rights reserved.