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Intake Forms and Intent Statements

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Mvita

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Ok, I have YET ANOTHER question! (Newbie).... :)

I am looking for an Health Intake Form...nothing too long....pretty basic with name address, DOB, stuff like that. I also want their health history where they check little boxes, maybe something that asks them if they've ever had a massage before, what they like, what they don't like, blah blah blah. I'd also like it to have the statement at the bottom that discusses that I cannot diagnose, they are responisble for charges, and something in there about sexual comments.

Here's my problem...I do not really like the ones that are offered on some of the websites. I don't do insurance, and I do not want ultra personal information on there like their SSN. I also don't want one that is like 3 pages long and they feel like they are at the doctor!

I'm hoping some of you might be willing to share your intake health forms and Informed Consent Forms. Please?! Please?!?! Please?!?!? Maybe you could e-mail it to me at my e-mail [email protected]. Or any advice you could give me I would HUGELY appreciate. Again, thanks for helping me out everyone! :smt055

Jen
 


Honestly... write your own. Take pieces from here and there of what you like and then just cut and paste. That is what I did...
 


Use Microsofts Word or Publisher.....they proabably have it on the Library computers if you don't have it.
Fashion it yourself.
There are lots of ad ons you can just click on ex. buttons, check boxes etc.

Robyn
 
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  1. EMSpa_schedule:
    Tomorrow's sneak peek: On Thursday January 16, 2025, our attendants will be Ada ๐Ÿ˜˜, Cici ๐Ÿฅฐ, Mia ๐Ÿค—, Vicky ๐Ÿ”ฅ and guest attendant Luna โค๏ธ We have a new guest attendant Luna joining us tomorrow! Call 905-479-6668 to book!
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    ๐Ÿ’†โ€โ™€๐Ÿ’–Terrific Thursday ๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: SL Richmond Hill & SL West Oakville โœจ Your passport to paradise with 10 enchanting girls fr China, HK, Japan & Korea โ€”๐Ÿ†•Stella, 34D Cici, Yoyo, Coco, Aaliyah, Selena, Yui, Tina, Michelle & New Kimmyโ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
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  4. lotushubspa:
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  5. Moneylee:
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  7. Moneylee:
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  9. Shangri-la Spa:
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  10. Sparkling Spa:
    โšก๏ธ๐ŸŒŸSPARKLING SPAโšก๏ธ๐ŸŒŸ โœ…50 Lockridge Ave Unit 8โœ… ๐Ÿ‘ŒMarkham, ON L3R 8X4๐Ÿ‘Œ โ˜Ž๏ธ (905) 604-8186 Spa Land Lineโ˜Ž๏ธ โ˜Ž๏ธ (437) 446-6688 NEW Spa Cell Phoneโ˜Ž๏ธ (West of Warden & 16th Ave) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…NEW MANAGEMENT๐Ÿ’ฏNEW GIRLS๐Ÿ”ฅSUPERSTAR SERVICE QUEENS AVAILABLE AT SPARKLING SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅSEXY NEW YOUNG GIRLS ALWAYS WORKING - Todayโ€™s Schedule isโ€ฆ๐Ÿ”ฅ Mimi๐Ÿ”ฅ๐Ÿ˜˜A captivating and alluring new massage girl from Korea whose elegance and c
  11. New spring spa@:
    ๐Ÿ’–๐Ÿ’–๐Ÿ’–sexy hot ๐ŸŒน ๐ŸŒน Philippine ๐ŸŒน๐ŸŒนMalaysia ๐ŸŒน๐ŸŒนkorean girls๐ŸŒน ๐ŸŒนworking ๐Ÿ’—๐Ÿ’—at markham โ˜Ž๏ธ416-669-8508 ๐Ÿ’‹๐Ÿ’‹โค๏ธโ€๐Ÿ”ฅโค๏ธโ€๐Ÿ”ฅ๐Ÿ’ฆnew girl arrive Judy mixes Philippine girl DD size busty, Bbbj , CIM , face spit . Call ask detail
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  17. Annie Spa:
    Our sexy busty Singapore girl Mia is back working at Annie spa with sexy sweet busty boobs Jenny. Itโ€™s big boobs days today at Annie Spa! Come see who has the biggest boobs and get your card stamped so you are on your way to a free massage๐Ÿ’ฏ๐Ÿ”ฅโค๏ธ๐Ÿ™๐Ÿป๐Ÿ‘Œ ๐ŸŽ‰๐Ÿ’ANNIE SPA๐ŸŽ‰๐Ÿ’ โœ…7-1001 SANDHURST CIRCLEโœ… ๐Ÿ‘ŒSCARBOROUGH ON M1V 1Z6๐Ÿ‘Œ โ˜Ž๏ธ (647) 891-9688โ˜Ž๏ธ โ˜Ž๏ธ (416) 291-8879โ˜Ž๏ธ (FINCH & MCCOWAN) OPEN 9:30am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…NEW MANAGEMENT๐Ÿ’ฏNEW GIRLS๐Ÿ”ฅ๐Ÿ”ฅ ๐Ÿ”ฅGORGEOUS NEW YOUNG ASIAN GIRLS - TODAY
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  29. Lulu1980:
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  33. EMSpa_schedule:
    Tomorrow's sneak peek: On Wednesday January 15, 2025, our attendants will be Carla ๐Ÿ‘, Opal ๐Ÿค—, Cici ๐Ÿ˜˜, Sandy ๐Ÿฅฐ and Yoyo ๐Ÿ”ฅ Come by and have an amazing massage!! Call 905-479-6668 to book
  34. New spring spa@:
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  35. Sparkling Spa:
    โšก๏ธ๐ŸŒŸSPARKLING SPAโšก๏ธ๐ŸŒŸ โœ…50 Lockridge Ave Unit 8โœ… ๐Ÿ‘ŒMarkham, ON L3R 8X4๐Ÿ‘Œ โ˜Ž๏ธ (905) 604-8186 Spa Land Lineโ˜Ž๏ธ โ˜Ž๏ธ (437) 446-6688 NEW Spa Cell Phoneโ˜Ž๏ธ (West of Warden & 16th Ave) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…NEW MANAGEMENT๐Ÿ’ฏNEW GIRLS๐Ÿ”ฅSUPERSTAR SERVICE QUEENS AVAILABLE AT SPARKLING SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅSEXY NEW YOUNG GIRLS ALWAYS WORKING - Todayโ€™s Schedule isโ€ฆ๐Ÿ”ฅ Coco -๐Ÿ”ฅ๐Ÿ˜˜Our new sexy and slim massage girl Coco exudes elegance and allure, with
  36. Lulu1980:
    Phoenix blossom Spa โ™จ๏ธโ™จ๏ธโ™จ๏ธtable shower ๐Ÿ‘๐Ÿ‘๐Ÿ‘๐Ÿ‘๐Ÿ‘body scrub๐ŸŒน๐ŸŒน๐ŸŒน๐ŸŒน5124 Dundas W Etobicoke โ˜Ž๏ธ416-817-3366 Nice girl Luna She can provide a very good massage with sensual touch. She knows how to take direction and please a man. Lisa ๐Ÿ˜˜can provide deep Thai massage. She takes directions very well. She has many assets and knows how to use them. Come see her today.Welcome to walk in or make an appointment at any time. Plenty of parking space
  37. Moneylee:
    All season wellness center: Young girl big boobs beautiful face deep massage Lulu,Young girl big boobs beautiful face deep massage Tina ,Young girl big breasted beautiful buttocks charming temperament big boobs Cindy ,Student big boobs buttocks Vicky, Enchanting sexy petite deep massage Sherry ,๐Ÿ address: #5-30 Rambler dr Brampton ,Ontario L6W 1E2โ˜Ž๏ธ4376655510 ๐Ÿ‘…๐Ÿ‘…๐Ÿฆต๐Ÿฆต๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿ‘„๐Ÿ‘„
  38. Moneylee:
    full season wellness center: NewYoung girl big breasted beautiful buttocks charming temperament April, Young girl big boobs beautiful face deep massage Grace,Young beautiful face sexy body and good deep massage Selena ,Young girl big boobs beautiful face deep massage Anika ,Young girl Big breasted saucy naughty Ella,Enchanting sexy petite deep massage Mary. ๐Ÿ  2560 Shepard ave Mississauga unit 1 โ˜Ž๏ธ 4379857899 ๐Ÿ‘„๐Ÿ‘„๐Ÿฆต๐Ÿฆต๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿ‘…๐Ÿ‘…
  39. New spring spa@:
    โค๏ธโ€๐Ÿ”ฅโค๏ธโ€๐Ÿ”ฅsexy hot busty ๐ŸŒธlatino๐ŸŒธMalaysia ๐ŸŒธKorean ๐ŸŒธgirls working at Markham โ˜Ž๏ธ416-669-8508โค๏ธโ€๐Ÿ”ฅโค๏ธโ€๐Ÿ”ฅ
  40. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅTODAYโ€™s ROSTER INCLUDES: Julia๐Ÿ˜˜ - A shy new Korean girl waiting
  41. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Today๐ŸŒธSusan๐ŸŒธCassy๐ŸŒธLynda๐ŸŒธBrandy๐ŸŒธLuna Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  42. Lily Spa:
    โค๏ธ KAJAL, LILY and KK are here today for your massage needs โค๏ธ Lily Spa โค๏ธ 2190 McNicoll โค๏ธ Scarborough โค๏ธ M1V 5M2 โค๏ธ (647) 531-8288 โค๏ธ
  43. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Meet๐ŸŒธClaire๐ŸŒธNina๐ŸŒธMariaCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  44. AliceSpa:
    TUESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—”, 4915 Steeles Ave. E, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿฎ๐Ÿต๐Ÿด-๐Ÿฌ๐Ÿด๐Ÿต๐Ÿด. 3 Young Beauties Today at Alice Spa. Open 10am to 9pm: BEBE : is a nice young Korean girl with a natural super busty DD Cup, petite small body, open minded bbby cim cof rim, always cooperative, excellent services. BELLA : is a young & pretty Taiwanese girl, busty D Cup, curvy body, deep bbbj, cfk, dim, finger in
  45. Eva Vivian - Elegant Asian Sweetheart:
    ๐Ÿ’ฏ๐Ÿ”ฅ๐Ÿ˜˜Iโ€™m Eva Vivian, your independent open minded slim sexy massage girl available working in Scarborough and North York. Available to provide you massage and extra services at Hawaii Health Spa in Scarborough, Red Rose Health Spa in Scarborough and Greenway Spa in North York๐Ÿ’ฏ๐Ÿ”ฅ๐Ÿ˜˜ RED ROSE HEALTH SPA: โœ…Red Rose Health Spa @ 2 Invergordon Avenue in Scarboroughโœ… โ˜Ž๏ธ416-292-1268โ˜Ž๏ธ ๐Ÿ’ฏVivian available every Sunday and Monday from 10am to 9pm๐Ÿ’ฏ โ˜Ž๏ธCall Red Rose Health Spa 416-292-1268 to book
  46. Endless Joy Spa:
    โœจโœจโœจโœจโœจ[GRAND OPENING]โœจโœจโœจโœจโœจ ๐Ÿ’žEndless Joy Spa๐Ÿ’ž ๐ŸŽ‡ (155 East Beaver Creek Rd Unit #8, Richmond Hill) 416-731-8565๐ŸŽ‡10am-2am, Slim Petite Chinese Vivi & Slim Sexy Chinese Coco & Young Slim Sexy Chinese Jasmine
  47. HollywoodSpa:
    Tuesday at ๐ŸŽญ๐—›๐—ข๐—Ÿ๐—Ÿ๐—ฌ๐—ช๐—ข๐—ข๐—— ๐—ฆ๐—ฃ๐—”๐ŸŽญ, 4578 Yonge St, Unit 100, North York, ON: COCO & SISI. โ˜Ž416-222-5554โ˜Ž When you visit ๐ŸŽญHollywood Spa๐ŸŽญ, you will be treated with tender care and your visit will be a fulfilling one. Nice Massage, Young Pretty Girls. We have Chinese, Japanese, Korean & other attendants. COCO is an attractive attendant with nice massage skills & good services. SISI is a sweet slim beauty, 5โ€™5โ€
  48. bnwellness_wilson:
    We have 4 girls are working today, young sweet Mia 25โ€™s and young fun Ivy 36DD with big buttocks open mind, sexy Coco and sweet EFG Lina are providing deep tissue and sensual massage, pls call 416-3985777 book appointment and walk in always welcome, back entrance and parking available. 350 Wilson Ave North York
  49. ForeverWarden:
    Tuesday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Cindy, Tracy & Vivian. Cindy is a slim beauty, 5โ€™4โ€, natural C Cups & wonderfully long nipples. Her massage is nice, her bbbj will drive you wild & her cfs finish is a dream come true. Tracy is an incredibly cute & pretty Japanese/Taiwanese mixed spinner, about 5โ€™1โ€ and 100 lbs. She is very popular
  50. HolidaySpa:
    Tuesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: EMMA, JENNY & CINDY. EMMA is a very beautiful slim Chinese honey with C Cups, beauty face, & nice services to drive you wild. Jenny has a medium build, nicely curvy with a slim waist, pretty face, and very flexible skills. Jenny will make you very happy CINDY is a slim & incredibly sexy lady

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